RF filter for an active medical device (AMD) for handling high RF power induced in an associated implanted lead from an external RF field

ABSTRACT

An RF filter for an active medical device (AMD), for handling RF power induced in an associated lead from an external RF field at a selected MRI frequency or range frequencies includes a capacitor having a capacitance of between 100 and 10,000 picofarads, and a temperature stable dielectric having a dielectric constant of 200 or less and a temperature coefficient of capacitance (TCC) within the range of plus 400 to minus 7112 parts per million per degree centigrade. The capacitor&#39;s dielectric loss tangent in ohms is less than five percent of the capacitor&#39;s equivalent series resistance (ESR) at the selected MRI RF frequency or range of frequencies.

CROSS-REFERENCE TO RELATED APPLICATIONS

The instant application is a continuation application claiming priorityto application Ser. No. 14/088,849 filed on Nov. 25, 2013 which itselfwas a continuation application of Ser. No. 13/408,020 filed on Feb. 29,2012 which itself claimed priority to provisional application 61/448,069filed on Mar. 1, 2011, the contents of all of which are fullyincorporated herein with these references.

DESCRIPTION

1. Field of the Invention

This invention generally relates to the problem of RF energy inducedinto implanted leads during medical diagnostic procedures such asmagnetic resonant imaging (MRI), and provides methods and apparatus forredirecting RF energy to locations other than the distal tipelectrode-to-tissue interface. In addition, the present inventionprovides electromagnetic interference (EMI) protection to sensitiveactive implantable medical device (AIMD) electronics.

2. Background of the Invention

Compatibility of cardiac pacemakers, implantable defibrillators andother types of active implantable medical devices with magneticresonance imaging (MRI) and other types of hospital diagnostic equipmenthas become a major issue. If one proceeds to the websites of the majorcardiac pacemaker manufacturers in the United States, which include St.Jude Medical, Medtronic and Boston Scientific (formerly Guidant), onewill see that the use of MRI is generally contra-indicated for patientswith implanted pacemakers and cardioverter defibrillators. See alsorecent press announcements of the Medtronic Revo MRI pacemaker which wasrecently approved by the U.S. FDA. With certain technical limitations asto scan type and location, this is the first pacemaker designed for MRIscanning. See also:

-   (1) “Safety Aspects of Cardiac Pacemakers in Magnetic Resonance    Imaging”, a dissertation submitted to the Swiss Federal Institute of    Technology Zurich presented by Roger Christoph Luchinger, Zurich    2002;-   (2) “1. Dielectric Properties of Biological Tissues: Literature    Survey”, by C. Gabriel, S. Gabriel and E. Cortout;-   (3) “II. Dielectric Properties of Biological Tissues: Measurements    and the Frequency Range 0 Hz to 20 GHz”, by S. Gabriel, R. W. Lau    and C. Gabriel;-   (4) “Ill. Dielectric Properties of Biological Tissues: Parametric    Models for the Dielectric Spectrum of Tissues”, by S. Gabriel, R. W.    Lau and C. Gabriel;-   (5) “Advanced Engineering Electromagnetics”, C. A. Balanis, Wiley,    1989;-   (6) Systems and Methods for Magnetic-Resonance-Guided Interventional    Procedures, Patent Application Publication US 2003/0050557, Susil    and Halperin et al., published Mar. 13, 2003;-   (7) Multifunctional Interventional Devices for MRI: A Combined    Electrophysiology/MRI Catheter, by, Robert C. Susil, Henry R.    Halperin, Christopher J. Yeung, Albert C. Lardo and Ergin Atalar,    MRI in Medicine, 2002; and-   (8) Multifunctional Interventional Devices for Use in MRI, U.S. Pat.    No. 7,844,534, Susil et al., issued Nov. 30, 2010.    The contents of the foregoing are all incorporated herein by    reference.

However, an extensive review of the literature indicates that, despitebeing contra-indicated, MRI is indeed often used to image patients withpacemaker, neurostimulator and other active implantable medical devices(AIMDs). As such, the safety and feasibility of MRI in patients withcardiac pacemakers is an issue of gaining significance. The effects ofMRI on patients' pacemaker systems have only been analyzedretrospectively in some case reports. There are a number of papers thatindicate that MRI on new generation pacemakers can be conducted up to0.5 Tesla (T). MRI is one of medicine's most valuable diagnostic tools.MRI is, of course, extensively used for imaging, but is also used forinterventional medicine (surgery). In addition, MRI is used in real timeto guide ablation catheters, neurostimulator tips, deep brain probes andthe like. An absolute contra-indication for pacemaker or neurostimulatorpatients means that these patients are excluded from MRI. This isparticularly true of scans of the thorax and abdominal areas. Because ofMRI's incredible value as a diagnostic tool for imaging organs and otherbody tissues, many physicians simply take the risk and go ahead andperform MRI on a pacemaker patient. The literature indicates a number ofprecautions that physicians should take in this case, including limitingthe power of the MRI RF pulsed field (Specific Absorption Rate—SARlevel), programming the pacemaker to fixed or asynchronous pacing mode,and then careful reprogramming and evaluation of the pacemaker andpatient after the procedure is complete. There have been reports oflatent problems with cardiac pacemakers or other AIMDs after an MRIprocedure sometimes occurring many days later. Moreover, there are anumber of recent papers that indicate that the SAR level is not entirelypredictive of the heating that would be found in implanted leads ordevices. For example, for magnetic resonance imaging devices operatingat the same magnetic field strength and also at the same SAR level,considerable variations have been found relative to heating of implantedleads. It is speculated that SAR level alone is not a good predictor ofwhether or not an implanted device or its associated lead system willoverheat.

There are three types of electromagnetic fields used in an MRI unit. Thefirst type is the main static magnetic field designated Bo which is usedto align protons in body tissue. The field strength varies from 0.5 to3.0 Tesla in most of the currently available MRI units in clinical use.Some of the newer MRI system fields can go as high as 4 to 5 Tesla. Atthe International Society for Magnetic Resonance in Medicine (ISMRM),which was held on 5-6 Nov. 2005, it was reported that certain researchsystems are going up as high as 11.7 Tesla and will be ready sometime in2010. This is over 100,000 times the magnetic field strength of theearth. A static magnetic field can induce powerful mechanical forces andtorque on any magnetic materials implanted within the patient. Thiswould include certain components within the cardiac pacemaker itselfand/or lead systems. It is not likely (other than sudden system shutdown) that the static MRI magnetic field can induce currents into thepacemaker lead system and hence into the pacemaker itself. It is a basicprinciple of physics that a magnetic field must either be time-varyingas it cuts across the conductor, or the conductor itself must movewithin a specifically varying magnetic field for currents to be induced.

The second type of field produced by magnetic resonance imaging is thepulsed RF field which is generated by the body coil or head coil. Thisis used to change the energy state of the protons and elicit MRI signalsfrom tissue. The RF field is homogeneous in the central region and hastwo main components: (1) the electric field is circularly polarized inthe actual plane; and (2) the H field, sometimes generally referred toas the net magnetic field in matter, is related to the electric field byMaxwell's equations and is relatively uniform. In general, the RF fieldis switched on and off during measurements and usually has a frequencyof about 21 MHz to about 500 MHz depending upon the static magneticfield strength. The frequency of the RF pulse for hydrogen scans variesby the Lamour equation with the field strength of the main static fieldwhere: RF PULSED FREQUENCY in MHz=(42.56) (STATIC FIELD STRENGTH INTESLA). There are also phosphorous and other types of scanners whereinthe Lamour equation would be different. The present invention applies toall such scanners.

The third type of electromagnetic field is the time-varying magneticgradient fields designated Bx, BY, BZ, which are used for spatiallocalization. These change their strength along different orientationsand operating frequencies on the order of 2-5 kHz. The vectors of themagnetic field gradients in the X, Y and Z directions are produced bythree sets of orthogonally positioned coils and are switched on onlyduring the measurements. In some cases, the gradient field has beenshown to elevate natural heart rhythms (heart beat). This is notcompletely understood, but it is a repeatable phenomenon. The gradientfield is not considered by many researchers to create any other adverseeffects.

It is instructive to note how voltages and electro-magnetic interference(EMI) are induced into an implanted lead system. At very low frequency(VLF), voltages are induced at the input to the cardiac pacemaker ascurrents circulate throughout the patient's body and create voltagedrops. Because of the vector displacement between the pacemaker housingand, for example, the tip electrode, voltage drop across the resistanceof body tissues may be sensed due to Ohms Law and the circulatingcurrent of the RF signal. At higher frequencies, the implanted leadsystems actually act as antennas where voltages (EMFs) are induced alongtheir length. These antennas are not very efficient due to the dampingeffects of body tissue; however, this can often be offset by extremelyhigh power fields (such as MRI pulsed fields) and/or body resonances. Atvery high frequencies (such as cellular telephone frequencies), EMIsignals are induced only into the first area of the leadwire system (forexample, at the header block of a cardiac pacemaker). This has to dowith the wavelength of the signals involved and where they coupleefficiently into the system.

Magnetic field coupling into an implanted lead system is based on loopareas. For example, in a cardiac pacemaker unipolar lead, there is aloop formed by the lead as it comes from the cardiac pacemaker housingto its distal tip electrode, for example, located in the rightventricle. The return path is through body fluid and tissue generallystraight from the tip electrode in the right ventricle back up to thepacemaker case or housing. This forms an enclosed area which can bemeasured from patient X-rays in square centimeters. The average looparea is 200 to 225 square centimeters. This is an average and is subjectto great statistical variation. For example, in a large adult patientwith an abdominal pacemaker implant, the implanted loop area is muchlarger (around 400 square centimeters).

Relating now to the specific case of MRI, the magnetic gradient fieldswould be induced through enclosed loop areas. However, the pulsed RFfields, which are generated by the body coil, would be primarily inducedinto the lead system by antenna action. Subjected to RF frequencies, thelead itself can exhibit complex transmission line behavior.

At the frequencies of interest in MRI, RF energy can be absorbed andconverted to heat. The power deposited by RF pulses during MRI iscomplex and is dependent upon the power (Specific Absorption Rate (SAR)Level) and duration of the RF pulse, the transmitted frequency, thenumber of RF pulses applied per unit time, and the type of configurationof the RF transmitter coil used. The amount of heating also depends uponthe volume of tissue imaged, the electrical resistivity of tissue andthe configuration of the anatomical region imaged. There are also anumber of other variables that depend on the placement in the human bodyof the AIMD and the length and trajectory of its associated lead(s). Forexample, it will make a difference how much EMF is induced into apacemaker lead system as to whether it is a left or right pectoralimplant. In addition, the routing of the lead and the lead length arealso very critical as to the amount of induced current and heating thatwould occur. Also, distal tip design is very important as it can heat updue to MRI RF induced energy.

The cause of heating in an MRI environment is twofold: (a) RF fieldcoupling to the lead can occur which induces significant local heating;and (b) currents induced between the distal tip and tissue during MRI RFpulse transmission sequences can cause local Ohms Law (resistive)heating in tissue next to the distal tip electrode of the implantedlead. The RF field of an MRI scanner can produce enough energy to induceRF voltages in an implanted lead and resulting currents sufficient todamage some of the adjacent myocardial tissue. Tissue ablation(destruction resulting in scars) has also been observed. The effects ofthis heating are not readily detectable by monitoring during the MRI.Indications that heating has occurred would include an increase inpacing threshold, venous ablation, Larynx or esophageal ablation,myocardial perforation and lead penetration, or even arrhythmias causedby scar tissue. Such long term heating effects of MRI have not been wellstudied yet for all types of AIMD lead geometries. There can also belocalized heating problems associated with various types of electrodesin addition to tip electrodes. This includes ring electrodes or padelectrodes. Ring electrodes are commonly used with a wide variety ofimplanted devices including cardiac pacemakers, and neurostimulators,and the like. Pad electrodes are very common in neurostimulatorapplications. For example, spinal cord stimulators or deep brainstimulators can include a plurality of pad electrodes to make contactwith nerve tissue. A good example of this also occurs in a cochlearimplant. In a typical cochlear implant there would be sixteen padelectrodes placed up into the cochlea. Several of these pad electrodesmake contact with auditory nerves.

Although there are a number of studies that have shown that MRI patientswith active implantable medical devices, such as cardiac pacemakers, canbe at risk for potential hazardous effects, there are a number ofreports in the literature that MRI can be safe for imaging of pacemakerpatients when a number of precautions are taken (only when an MRI isthought to be an absolute diagnostic necessity). While these anecdotalreports are of interest, they are certainly not scientificallyconvincing that all MRI can be safe. For example, just variations in thepacemaker lead length and implant trajectory can significantly affecthow much heat is generated. A paper entitled, HEATING AROUNDINTRAVASCULAR GUIDEWIRES BY RESONATING RF WAVES by Konings, et al.,journal of Magnetic Resonance Imaging, Issue 12:79-85 (2000), does anexcellent job of explaining how the RF fields from MRI scanners cancouple into implanted leads. The paper includes both a theoreticalapproach and actual temperature measurements. In a worst-case, theymeasured temperature rises of up to 74 degrees C. after 30 seconds ofscanning exposure. The contents of this paper are incorporated herein byreference.

The effect of an MRI system on the function of pacemakers, ICDs,neurostimulators and the like, depends on various factors, including thestrength of the static magnetic field, the pulse sequence, the strengthof RF field, the anatomic region being imaged, and many other factors.Further complicating this is the fact that each patient's condition andphysiology is different and each lead implant has a different lengthand/or implant trajectory in body tissues. Most experts still concludethat MRI for the pacemaker patient should not be considered safe.

It is well known that many of the undesirable effects in an implantedlead system from MRI and other medical diagnostic procedures are relatedto undesirable induced EMFs in the lead system and/or RF currents in itsdistal tip (or ring) electrodes. This can lead to overheating of bodytissue at or adjacent to the distal tip.

Distal tip electrodes can be unipolar, bipolar and the like. It is veryimportant that excessive current not flow at the interface between thelead distal tip electrode and body tissue. In a typical cardiacpacemaker, for example, the distal tip electrode can be passive or of ascrew-in helix type as will be more fully described. In any event, it isvery important that excessive RF current not flow at this junctionbetween the distal tip electrode and for example, myocardial or nervetissue. Excessive current at the distal electrode to tissue interfacecan cause excessive heating to the point where tissue ablation or evenperforation can occur. This can be life threatening for cardiacpatients. For neurostimulator patients, such as deep brain stimulatorpatients, thermal injury can cause coma, permanent disability or even belife threatening. Similar issues exist for spinal cord stimulatorpatients, cochlear implant patients and the like.

Interestingly, the inventors performed an experiment in an MRI scannerwith a human body gel-filled phantom. In the phantom, placed in ananatomic position, was an operating pacemaker and a lead. This wasduring evaluation of the efficacy of bandstop filters at or near thedistal tip electrode for preventing the distal tip electrode fromoverheating. Bandstop filters for this purpose are more thoroughlydescribed in U.S. Pat. No. 7,363,090, the contents of which areincorporated herein by reference. During the experiments, there was acontrol lead that had no bandstop filter. During a particularly RFintense scanning sequence, Luxtron probes measured a distal helix tipelectrode temperature rise of 30 degrees C. Of course, the 30 degrees C.temperature rise in a patient, would be very alarming as it could leadto pacing capture threshold changes or even complete loss capture due toscar tissue formation. An identical lead with the bandstop filter inplace only had a temperature rise of 3 degrees C. This was a remarkablevalidation of the efficacy of bandstop filters for implantableelectrodes. However, something very interesting happened when wedisconnected the pacemaker. We disconnected the pacemaker and put asilicone lead cap over the proximal end of the lead. Again, we put thegel phantom back inside the MR scanner and this time we measured an 11degree C. temperature rise on the lead with the bandstop filter. Thiswas proof positive that the housing of the AIMD acts as part of thesystem. The prior art feedthrough capacitor created a fairly lowimpedance at the input to the pacemaker and thereby drew RF energy outof the lead and diverted it to the housing of the pacemaker. It hasrecently been discovered that the impedance, and in particular, the ESRof these capacitors, is very important so that maximal energy can bepulled from the lead and diverted to the pacemaker housing while at thesame time, not unduly overheating the feedthrough capacitor.

Accordingly, there is a need for novel low ESR diverting capacitors andcircuits which are frequency selective and are constructed of passivecomponents for implantable leads and/or leadwires. Further, there is aneed for very low ESR diverter element capacitor(s) which are designedto decouple a maximum amount of induced RF energy from an implanted leadto an AIMD housing while at the same time not overheat. The presentinvention fulfills these needs and provides other related advantages.

SUMMARY OF THE INVENTION

The present invention relates to an RF filter for an active medicaldevice (AMD) for handling high RF power induced in an associated leadfrom an external RF field at a selected MRI frequency or range offrequencies. In a preferred embodiment, the RF filter comprises acapacitor having a capacitance generally between about 10 to about20,000 picofarads, and a temperature stable dielectric having adielectric constant of about 200 or less. In addition, the dielectricmaterial should have a temperature coefficient of capacitance (TCC)within the range of plus 400 to minus 7112 parts per million per degreecentigrade (ppm/.degree. c.). Furthermore, the capacitor's dielectricloss tangent in ohms should be less than about five percent of thecapacitor's equivalent series resistance (ESR) at the selected MRIfrequency or range of frequencies.

In a second embodiment, the AIMD diverter capacitor 140 comprises atleast ten interleaved active and ground electrode plates designed tominimize the capacitor's high frequency ESR while maximizing internallygenerated heat flow from the capacitor. The ground electrode plates areconductively connected to an energy dissipating surface (EDS). Inpreferred embodiments of the invention, the EDS surface comprises ahousing of the AMD and/or a ferrule conductively attached to both theground electrode plates and the housing for the AMD.

Preferably, the capacitor's ESR at MRI RF pulsed frequencies should beless than about two ohms, more preferably, about less than 0.5, and mostpreferably, less than about 0.1 ohm. The capacitance should vary no morethan plus or minus about one percent over the temperature range of aboutminus 55 degrees C. to about plus 125 degrees C. Moreover, thecapacitor's dielectric loss tangent should be less than about two ohmsat the selected MRI RF frequency or range of frequencies.

Each dielectric layer may comprise multiple electrode plates.

The AIMD diverter capacitor may comprise a monolithic ceramic capacitor,a flat-through capacitor, a chip capacitor, an X2Y attenuator, or afeedthrough capacitor.

In several embodiments, the interleaved electrode plates are bounded atone end by a first set of at least one extra ground plate embeddedwithin the dielectric material. In other embodiments, a second set of atleast one ground plate is embedded within the dielectric material andbounds the interleaved electrode plates opposite the first set of groundplates.

The plurality of ground electrode plates may extend substantially to theperiphery of the capacitor. A high thermal conductivity material mayalso be utilized for attaching the ground electrode plates to a heatsink. The heat sink may comprise a conductive ferrule or a heatconductive structure affixed to the periphery of the capacitor. Theconductive structure may comprise a plurality of convection fins.

In a further embodiment, the AIMD diverter capacitor 140 may comprise anelement of a lowpass filter which can be combined with inductors to formeither an L filter, a reverse L filter, an LL, a reverse LL, a T, a Pior an n-element lowpass filter.

The lowpass filters, which can consist in the simplest embodiment ofjust a diverter capacitor, can also be combined within the AIMD withbandstop filters and L-C trap filters.

Other features and advantages of the present invention will becomeapparent from the following more detailed description, taken inconjunction with the accompanying drawings which illustrate, by way ofexample, the principles of the invention.

BRIEF DESCRIPTION OF THE DRAWINGS

The accompanying drawings illustrate the invention. In such drawings:

FIG. 1 is a wire-formed diagram of a generic human body showing a numberof exemplary implanted medical devices;

FIG. 2 is a pictorial view of an AIMD patient who is about to be placedinto an MRI scanner.

FIG. 3 shows a side view of the patient within the scanner showing anintense RF field impinging on the implanted medical device and itsassociated lead.

FIG. 4 is a top view of the patient in the MRI scanner showing onelocation of the AIMD and its associated lead.

FIG. 5 is a line drawing of a human heart with cardiac pacemaker dualchamber bipolar leads shown in the right ventricle and the right atrium;

FIG. 6 is a diagram of a unipolar active implantable medical device;

FIG. 7 is a diagram similar to FIG. 6, illustrating a bipolar AIMDsystem;

FIG. 8 is a diagram similar to FIGS. 6 and 7, illustrating a bipolarlead system with a distal tip and ring electrodes, typically used in acardiac pacemaker;

FIG. 9 illustrates a dual chamber cardiac pacemaker with its associatedleads and electrodes implanted into a human heart;

FIG. 10 is a perspective view of a rectangular broadband or lowpass EMIfilter capacitor;

FIG. 11 is a horizontal section taken generally along the line 11-11 ofFIG. 10, illustrating the configuration of active electrode plateswithin the rectangular capacitor;

FIG. 12 is a horizontal section taken generally along the lines 12-12 ofFIG. 10, illustrating the configuration of a set of ground electrodeplates within the rectangular capacitor;

FIG. 13 is a perspective view illustrating the rectangular feedthroughcapacitor of FIG. 10 mounted to a hermetic terminal;

FIG. 14 is an enlarged sectional view taken generally along the line14-14 of FIG. 13;

FIG. 15 is a perspective view of a round hermetic terminal showing aquadpolar RF diverter feedthrough capacitor;

FIG. 16 is an enlarged cross-sectional view taken generally along theline 16-16 from FIG. 15;

FIG. 17 is an enlarged sectional view taken generally along the line17-17 from FIG. 16, illustrating the configuration of active electrodeplates within the feedthrough energy diverter capacitor;

FIG. 18 is an enlarged sectional view taken generally along the line18-18 from FIG. 16, illustrating the configuration of ground electrodeplates within the feedthrough energy diverter capacitor;

FIG. 19 is an exploded perspective view illustrating the electrodelay-ups of the round quadpolar feedthrough capacitor shown in FIGS. 15and 16;

FIG. 20 is an electrical schematic diagram of the quadpolar feedthroughcapacitor of FIGS. 15-19;

FIG. 21 is a perspective view of a monolithic ceramic capacitor (MLCC);

FIG. 22 is a cross-sectional view of the monolithic ceramic capacitor,taken along the line 22-22 of FIG. 21;

FIG. 23 is an electrical schematic diagram of an ideal MLCC capacitor asillustrated in FIGS. 21 and 22;

FIG. 24 is a flat-through three-terminal capacitor;

FIG. 25 illustrates the internal electrode plates of the flat-throughcapacitor of FIG. 24;

FIG. 26 is a perspective exploded view of a multi-lead hermeticfeedthrough with substrate mounted MLCCs showing use of a substratebetween the feedthrough and the filter support assembly;

FIG. 27 illustrates a cross-sectional view of an MLCC capacitor mountedto separate circuit traces;

FIG. 28 is a schematic representation explaining the elements that arecomponents of the FIG. 27 capacitor's equivalent series resistance(ESR);

FIG. 29 is an equation that relates the capacitance with the capacitor'sactive area, dielectric constant, number of electrode plates anddielectric thickness;

FIG. 30 shows the difference between an ideal capacitor and a realcapacitor, including dielectric loss tangent and dissipation factor;

FIG. 31 gives the formulas for capacitive reactance, dissipation factor,equivalent series resistance (ESR) and dielectric loss tangent;

FIG. 32 is an equivalent circuit model for a real capacitor;

FIG. 33 is a schematic illustrating a simplified model for capacitorESR;

FIG. 34 is a graph illustrating capacitor dielectric loss versusfrequency;

FIG. 35 is a graph illustrating normalized curves which show thecapacitor equivalent series resistance (ESR) on the y axis, versusfrequency on the x axis;

FIG. 36 illustrates the reactance and real losses of a 2000 picofaradX7R feedthrough capacitor;

FIG. 37 illustrates the reactance and real losses of a 2000 picofaradCOG (NPO) capacitor;

FIG. 38 is a graph illustrating capacitor equivalent series resistanceversus frequency as illustrated in a sweep from an Agilent E4991Amaterials analyzer;

FIG. 39 is a cross-sectional view of a lower k MLCC with an increasednumber of electrode plates to minimize ESR;

FIG. 40 is an equation showing that the total high frequency electroderesistive losses drop in accordance with the parallel plate formula forcapacitor electrodes.

FIG. 41 is a cross-sectional view of a quad polar feedthrough capacitorsimilar to FIG. 15 except that it is low ESR and designed for maximalheat flow;

FIG. 42 is a partial section taken from section 42-42 from FIG. 41illustrating dual electrode plates to minimize capacitor ESR andmaximize heat flow out of the capacitor;

FIG. 43 is similar to FIG. 42 except that just the ground electrodeplates have been doubled;

FIG. 44 is similar to FIG. 43 except that 3 or even “n” ground electrodeplates are illustrated;

FIG. 45 is a partial section taken from section 45-45 from FIG. 41illustrating conductive spheres in a thermal-setting conductiveadhesive;

FIG. 46 is similar to FIG. 45 illustrating that the conductive spheresare of varying diameters;

FIG. 47 is similar to FIGS. 45 and 46 except that the conductive sphereshave been replaced by overlaying conductive flakes;

FIG. 48 is similar to FIGS. 45-47 except the conductive spheres havebeen replaced by conductive rods or similar structures;

FIG. 49 indicates that the highly thermally-conductive matrix can beformed by combining the spheres of FIG. 46, the flakes of FIG. 47 andthe rods of FIG. 48.

FIG. 50 is similar to FIG. 41 except that extra ground electrode plateshave been added to the bottom of the capacitor to facilitate additionalheat transfer out of the capacitor through the ferrule and into the AIMDhousing;

FIG. 51 is similar to FIG. 41 except that extra ground electrode plateshave been added to the top and bottom of the capacitor to facilitateadditional heat conduction out of the capacitor through the ferrule andinto the AIMD housing;

FIG. 52 is similar to FIG. 50 except that additional ground plates havebeen added to both the bottom and top of the capacitor to facilitateadditional heat transfer. Also shown is an optional highlythermally-conductive overlay or adhesive;

FIG. 53 is similar to FIG. 52 except that the thermally-conductiveover-coating material has been extended to coat over the ferrule and aportion of the inside of the AIMD housing;

FIG. 54 is very similar to the capacitor of FIG. 50 except thatthermally-conductive ground plates have been added to the hermeticinsulator to provide an additional conductive heat path;

FIG. 55 illustrates that a parasitic capacitance has been formed in thealumina insulator which enhances high frequency filter performance;

FIG. 56 is similar to FIG. 54 except that in this case the divertercapacitor 140 is disposed on the body fluid side where it is coveredwith a highly thermally-conductive material;

FIG. 57 is similar to FIG. 53 except that a highly thermally conductiveliner has been added on the inside of the AIMD housing to furtherfacilitate heat flow away from the capacitor;

FIG. 58 is very similar to FIG. 57 except that a weld shield has beenadded which assists in thermal conductance away from the capacitor;

FIG. 59 is similar to FIG. 57 except that the capacitor perimetermetallization has been increased in thickness;

FIG. 60 is similar to FIG. 59 except that a highly thermally-conductivematerial has been co-bonded to the hermetic insulator;

FIG. 61 is similar to FIG. 59 except that a highly thermally-conductivewasher has been disposed between the capacitor and the hermeticinsulator;

FIG. 62 illustrates the capacitor completely embedded and over-molded bya highly thermally-conductive material;

FIG. 63 illustrates a round quad polar capacitor similar to FIG. 15;

FIG. 64 is a sectional view taken from section 64-64 from FIG. 63;

FIG. 65 is a top sectional view taken from section 65-65 from FIG. 64showing that the capacitor electrical connection is interposed betweenareas of high thermal conductivity material;

FIG. 66 is similar to FIG. 63 except that heat radiating fins have beenadded;

FIG. 67 is a sectional view taken from section 67-67 from FIG. 66;

FIG. 68 is similar to FIG. 67 except that the heat radiating fins aredisposed well above the ferrule;

FIG. 69 illustrates a cutaway of an AIMD housing with a fill tube;

FIG. 70 is similar to FIG. 69 and illustrates the AIMD has been filledeither with a high pressure gas or a liquid;

FIG. 71 is a flow chart of the process of FIGS. 69 and 70;

FIG. 72 illustrates using powder metallurgy or other techniques to add ahighly thermally-conductive layer to the ferrule;

FIG. 73 is similar to FIG. 72 showing co-bonding a highlythermally-conductive material to the ferrule;

FIG. 74 is an inline quad polar capacitor similar to FIG. 13;

FIGS. 75A and 75B illustrate relatively high ESR electrode platearrangements;

FIGS. 76A and 76B illustrate a medium ESR electrode arrangement;

FIGS. 77A and 77B illustrate a very low ESR electrode arrangement;

FIGS. 78A and 78B illustrate a composite low ESR and highlythermally-conductive electrode attachment;

FIG. 79 illustrates a family of lowpass filters indicating the presentinvention can be anything from a simple diverter capacitor 140 to an “n”element lowpass filter;

FIG. 80 illustrates that a bandstop filter can be combined with any ofthe lowpass filters of FIG. 79;

FIG. 81 illustrates that an L-C trap filter may also be added incombination with any of the circuits of FIG. 79 or 80;

FIG. 82 illustrates a general lowpass filter, a bandstop filter and anL-C trap;

FIG. 83 illustrates a feedthrough diverter capacitor, a bandstop filterand an L-C trap.

FIG. 84 illustrates a cardiac pacemaker with a diverter feedthroughcapacitor and also a circuit board mounted chip capacitor filter whichforms a composite filter and also spreads out heat generation;

FIG. 85 is a fragmented perspective view of an EMI shield conduitmounted to a circuit board having multiple MLCC chip capacitors;

FIG. 86 is a cross-sectional view of an improved flex cable embodyingthe present invention;

FIG. 87 is a sectional view taken along line 87-87 of FIG. 86;

FIG. 88 is a sectional view taken along the line 88-88 of FIG. 86,illustrating an alternative to the internal circuit traces describedwith respect to FIG. 87;

FIG. 89 is a sectional view taken along line 89-89 of FIG. 86,illustrating one of a pair of coaxially surrounding shields disposedabout the circuit trace;

FIG. 90 is a perspective view of the flex cable of FIG. 86 connected toa circuit board or substrate having a flat-through capacitor;

FIG. 91 is the top view of the flat-through capacitor from FIG. 90;

FIG. 92 illustrates the active electrode plates of the flat-throughcapacitor of FIGS. 90 and 91; and

FIG. 93 illustrates the ground electrode plate set of the flat-throughcapacitor of FIGS. 90 and 91.

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

FIG. 1 illustrates various types of active implantable medical devicesreferred to generally by the reference numeral 100 that are currently inuse. FIG. 1 is a wire formed diagram of a generic human body showing anumber of exemplary implanted medical devices. Numerical designation100A is a family of implantable hearing devices which can include thegroup of cochlear implants, piezoelectric sound bridge transducers andthe like. Numerical designation 100B includes an entire variety ofneurostimulators and brain stimulators. Neurostimulators are used tostimulate the Vagus nerve, for example, to treat epilepsy, obesity anddepression. Brain stimulators are similar to a pacemaker-like device andinclude electrodes implanted deep into the brain for sensing the onsetof the seizure and also providing electrical stimulation to brain tissueto prevent the seizure from actually happening. Numerical designation100C shows a cardiac pacemaker which is well-known in the art. Numericaldesignation 100D includes the family of left ventricular assist devices(LVAD's), and artificial hearts, including the recently introducedartificial heart known as the Abiocor. Numerical designation 100Eincludes an entire family of drug pumps which can be used for dispensingof insulin, chemotherapy drugs, pain medications and the like. Insulinpumps are evolving from passive devices to ones that have sensors andclosed loop systems. That is, real time monitoring of blood sugar levelswill occur. These devices tend to be more sensitive to EMI than passivepumps that have no sense circuitry or externally implanted leadwires.100F includes a variety of implantable bone growth stimulators for rapidhealing of fractures. Numerical designation 1000 includes urinaryincontinence devices. Numerical designation 100H includes the family ofpain relief spinal cord stimulators and anti-tremor stimulators.Numerical designation 100H also includes an entire family of other typesof neurostimulators used to block pain. Numerical designation 100Iincludes a family of implantable cardioverter defibrillator (ICD)devices and also includes the family of congestive heart failure devices(CHF). This is also known in the art as cardio resynchronization therapydevices, otherwise known as CRT devices. Numerical designation 100Jillustrates an externally worn pack. This pack could be an externalinsulin pump, an external drug pump, an external neurostimulator or evena ventricular assist device.

Referring to U.S. 2003/0050557, Paragraphs 79 through 82, the contentsof which are incorporated herein, metallic structures, particularlyleads, are described that when placed in MRI scanners, can pick up highelectrical fields which results in local tissue heating. This heatingtends to be most concentrated at the ends of the electrical structure(either at the proximal or distal lead ends). This safety issue can beaddressed using the disclosed systems and methods of the presentinvention. A significant concern is that the distal electrodes, whichare in contact with body tissue, can cause local tissue burns.

As used herein, the lead means an implanted lead, including itsconductors and electrodes that have electrodes that are in contact withbody tissue. In general, for an AIMD, the term lead means the lead thatis outside of the AIMD housing and is implanted or directed into bodytissues. The term leadwire as used herein refers to the wiring orcircuit traces that are generally inside of the active implantablemedical device (AIMD) and are not exposed directly to body fluids.

FIG. 2 illustrates an AIMD patient 102 about to be conveyored into anMRI machine 104. Imaging processing equipment is shown as 106.

FIG. 3 is a side view showing the patient 102 within the MRI scannerbore 104. Intense RF field 108 is generated by the scanners bird cagecoil. As can be seen, this RF field is impinging on both the implantedcardiac pacemaker 100C and its associated leads 110.

FIG. 4 is a top view of the patient 102 inside the MRI scanner bore 104.As can be seen, the pacemaker 100C is in a left pectoral pocket with theleads 110 routed transvenously down into the interior chambers of theheart.

FIG. 5 is a line drawing of a human heart 112 with cardiac pacemaker100C dual chamber bipolar leads shown in the right ventricle 114 and theright atrium 116 of a human heart 112.

Referring once again to FIG. 5, as previously mentioned, it is veryimportant that this lead system does not overheat during MRI proceduresparticularly at or near the distal tip 118 a, 118 b electrodes and ringelectrodes 120 a, 120 b. If either or both the distal tip 118 a, 118 band ring 120 a, 120 b electrode become overgrown by body tissue,excessive overheating can cause scarring, burning or necrosis of saidtissues. This can result in loss of capture (loss pacing pulses) whichcan be life-threatening for a pacemaker dependent patient. It is alsothe case where implanted leads are often abandoned (where the lead hasbeen permanently disconnected from the AIMD). Often times when thedevice such as a pacemaker 100C shown in FIG. 5 is changed out, forexample, due to low battery life and a new pacemaker is installed, thephysician may decide to install new leads at the same time. Leads arealso abandoned for other reasons, such as a dislodged or a highimpedance threshold or high leakage current. Sometimes over the courseof a patient life-time, the distal tip electrode to tissue interfaceincreases in impedance. This means that the new pacemaker would have topulse at a very high voltage output level which would quickly depleteits battery life. This is yet another example of why a physician wouldchoose to insert new leads. Sometimes the old leads are simplyextracted. However, this is a very complicated surgical procedure whichdoes involve risks to the patient. Fortunately, there is usually plentyof room in the venous system and in the tricuspid valve to placeadditional leads through the same pathway. The physician may also chooseto implant the pacemaker on the other side. For example, if the originalpacemaker was in the right pectoral region, the physician may removethat pacemaker and choose to install the new pacemaker in the leftpectoral region using a different part of the venous system to gain leadaccess. In either case, the abandoned leads can be very problematicduring an MRI procedure. In general, prior art abandoned leads arecapped with a silicone cap at their proximal connector points so thatbody fluids will not enter into the lead system, cause infections andthe like. However, it has been shown in the literature that the distalelectrodes 118, 120 of abandoned leads are at high risk to heat upduring MRI procedures. Accordingly, a passive frequency selectivecircuit of the present invention is very useful when placed at or nearthe proximal electrical contact after a pacemaker is removed and itsleads are disconnected (abandoned). For example, for an abandoned (leftin the body) lead, an energy dissipating surface 122 at or near theproximal lead end is an ideal place to eliminate excess energy inducedby MRI in the leadwire system. The energy dissipating surface 122 mayincorporate a high RF power diverter capacitor 140 of the presentinvention. Referring once again to FIG. 5, one can see that there is adistal tip electrode 118 and a ring electrode 120 placed in the rightventricle 114 and a distal tip electrode 118 and distal ring electrode120 placed in the right atrium 116. Those skilled in the art willrealize that many different lead configurations are possible for thehuman heart and also other neurostimulator applications.

FIG. 6 is a general diagram of a unipolar active implantable medicaldevice 100 and related lead system. The housing 124 of the activeimplantable medical device 100 is typically titanium, ceramic, stainlesssteel or the like. Inside of the device housing 124 are the AIMDelectronic circuits. Usually AIMDs include a battery, but that is notalways the case. A leadwire or lead 110 is routed from the AIMD 100 to adistal electrode) 18, 120 typically including or comprising an electrodeembedded in, affixed to, or in contact with body tissue. In the case ofa spinal cord stimulator 100H (FIG. 1), the distal electrode 118, 120could be in the spinal cord. In the case of a deep brain stimulator 1008(FIG. 1), the distal electrode 118, 120 would be placed deep into thebrain, etc. In the case of a cardiac pacemaker 100C (FIG. 1), the distalelectrode 118, 120 would typically be placed in or outside of a cardiacchamber. The unipolar electrical return path is between the distalelectrode through body tissue to the conductive housing 124 of theimplantable unipolar medical device 100.

FIG. 7 is very similar to FIG. 6 except that it depicts a bipolar AIMD100 and related lead system. In this case, a first lead conductor 110 ais coupled to a first distal electrode 118, and a second distalelectrode 120 and associated lead conductor 110 b provide an electriccircuit return path between the two distal electrodes 118 and 120. Inthe case where the AIMD 100 is a cardiac pacemaker 100C, this would beknown as a bipolar lead system with one of the electrodes known as thedistal tip electrode 118 and the other electrode (which would float inthe blood pool) known as the ring electrode 120.

In all of these applications, the patient could be exposed to the fieldsof an MRI scanner or other powerful emitter used during a medicaldiagnostic procedure, currents that are directly induced in the leads110 a, 110 b can cause heating by P=I²R (Ohm's law) losses in the leadsor by heating caused by RF current flowing from the tip and ringelectrodes 118, 120 into body tissue. If these induced RF currentsbecome excessive, the associated heating can cause damage or evendestructive ablation to body tissue. These induced currents and voltagesin an implanted lead can also cause EMI problems to the AIMD. AIMD EMIcan include oversensing, device re-set, mode-switching, pacinginhibition or inappropriate therapy delivery.

In FIG. 8, the AIMD 100 is a cardiac pacemaker 100C wherein the distaltip electrode 118 is designed to be implanted against or into or affixed(screwed into) to the myocardial tissue of the heart 112. The ringelectrode 120 is designed to float in the blood pool within a cardiacventricle.

FIG. 9 is a pectoral view of a prior art cardiac pacemaker 100C showingdual chamber bipolar leads 110, 110′ routed to distal tip electrodes 118a and 118 b and distal ring electrode 120 a and 120 b. As can be seen,the leads 110, 110′ are exposed to a powerful RF-pulsed field from anMRI machine. This induces electromagnetic energy on the leads which arecoupled via ISO Standard IS-1 or DF-1 connectors 126, 128 through headerblock 138 which connects the leads to electronic circuits 130 inside ofthe hermetically sealed pacemaker housing 124. A hermetic seal assembly132 is shown with a metal ferrule 134 which is generally laser weldedinto the titanium housing 124 of the cardiac pacemaker 100C. Lead wires136 a through 136 d penetrate the ferrule 134 of the hermetic seal innon-conductive relation. Glass seals or gold brazes are formed toperfect the hermetic seal which keeps body fluids from getting to theinside of the pacemaker housing 124.

FIGS. 10-14 illustrate a prior art rectangular bipolar feedthroughcapacitor (planar array) 140 mounted to the hermetic terminal 132 of acardiac pacemaker in accordance with U.S. Pat. No. 5,333,095 toStevenson et al. the contents of which are incorporated herein. Asillustrated in FIGS. 10-14, in a typical broadband or lowpass EMI filterconstruction, a ceramic feedthrough filter capacitor, 140 is used in ahermetic feedthrough assembly 132 to suppress and decouple undesiredinterference or noise transmission along one or more terminal pins 142,and may comprise a capacitor having two sets of electrode plates 144 and146 embedded in spaced relation within an insulative dielectricsubstrate or base 148, formed typically as a ceramic monolithicstructure. One set of the electrode plates 144 is electrically connectedat an inner diameter cylindrical surface of the capacitor structure 140to the conductive terminal pins 142 utilized to pass the desiredelectrical signal or signals (see FIG. 11). The other or second set ofelectrode plates 146 is coupled at a sidewall of the dielectricproviding an outer edge surface of the capacitor 140 throughmetallization to a rectangular ferrule 134 of conductive material. Inthe prior art, without regard to high frequency capacitor ESR, thenumber and dielectric thickness spacing of the electrode plate sets 144,146 varies in accordance with the capacitance value and the voltagerating of the capacitor 140.

In operation, the coaxial capacitor 140 permits passage of relativelylow frequency electrical signals along the terminal pins 142, whileshielding and decoupling/attenuating undesired interference signals oftypically high frequency to the conductive housing 124. Feedthroughcapacitors 140 of this general type are available in unipolar (one),bipolar (two), tripolar (three), quadpolar (four), pentapolar (five),hexpolar (6) and additional lead configurations. Feedthrough capacitors140 (in both discoidal and rectangular configurations) of this generaltype are commonly employed in implantable cardiac pacemakers anddefibrillators and the like, wherein the pacemaker housing isconstructed from a biocompatible metal such as titanium alloy, which iselectrically and mechanically coupled to the hermetic terminal pinassembly which is in turn electrically coupled to the coaxialfeedthrough filter capacitor. As a result, the filter capacitor andterminal pin assembly prevent entrance of interference signals to theinterior of the pacemaker housing 124, wherein such interference signalscould otherwise adversely affect the desired cardiac pacing ordefibrillation function.

FIG. 11 illustrates the configuration of active electrode plates 144within the rectangular capacitor 140.

FIG. 12 illustrates the configuration of a set of ground electrodeplates 146 within the rectangular capacitor 140.

FIG. 13 shows a quadpolar feedthrough capacitor 140 (which is identicalto the capacitor of FIG. 10) mounted to the hermetic terminal 132. Asone can see in FIG. 13, the conductive polyimide material 152 connectsbetween the capacitor metallization 150 and the gold braze area 154. Thegold braze 154 forms a metallurgical bond with the titanium andprecludes any possibility of an unstable oxide forming. Gold is a noblemetal that does not oxidize and remains very stable even at elevatedtemperatures. The novel construction methodology illustrated in FIG. 13guarantees that the capacitor ohmic losses will remain very small at allfrequencies. By connecting the capacitor's electrode plates to a lowresistivity surface such as gold, one is guaranteed that this connectionwill not substantially contribute to the capacitor's overall ESR.Keeping the ESR as low as possible is very important for diverting ahigh amount of RF current such as that induced in the lead system by MRIscanners. One is referred to U.S. Pat. No. 6,765,779 to Stevenson etal., for additional information on electrically connecting tonon-oxidized surfaces, the contents of which are incorporated herein byreference.

FIG. 14 is a cross-section of the capacitor shown in FIG. 13. One cansee that the gold braze (or weld) areas 154 a and 154 b that form thehermetic seal between the alumina insulator 156 and the titanium ferrule134 are desirably on the feedthrough capacitor side. This makes it easyto manufacture the gold bond pad area 158 for convenient attachment ofthe conductive thermal-setting material 152. In other words, by havingthe gold braze hermetic seals 154 on the same side as the gold bond padarea 158, these can be co-formed in one manufacturing operation in agold braze vacuum furnace. Further, a unique insulative material 160 isdisposed between the capacitor 140 and the underlying hermetic terminal132.

FIG. 15 is a quad polar feedthrough capacitor 140 mounted to a hermeticterminal 132 similar to that described in FIG. 13 except that in thiscase, the structure is round or discoidal.

FIG. 16 is a cross-sectional view taken generally from section 16-16from FIG. 15. There are four feedthrough leadwires 142 which extendthrough the capacitor 140, which has a ground electrode plate set 146and an active electrode plate set 144.

FIG. 17 is a cross-sectional view taken from section 17-17 from FIG. 16and illustrates a prior art electrode plate set 144 in that there arevery few electrodes. As shown there are only two active electrodes 144and three ground electrodes 146. This low electrode plate count resultsin a feedthrough diverter capacitor 140 that has a relatively high ESRat high frequencies. In a recent experiment conducted by the inventors,a typical EIA X7R 400 picofarad feedthrough capacitor with only fourelectrode plates had an ESR at 1 MHz of 16 Ohms. Re-design of the samegeometry (size) capacitor with an EIA NPO dielectric resulted in a 400picofarad capacitor with over 20 electrodes and an ESR of approximately1 Ohm at 1 MHz (and around 300 milliohms at 64 MHz). This sixteen to onereduction is a dramatic illustration of the importance of designing theAIMD MRI diverter capacitor 140 for low ESR. For example, for an X7Rcapacitor the impedance would be the square root of the sum of thecapacitor's reactance squared plus the ESR squared. This results in acapacitor impedance Z which is equal to −j6.22+16 or approximately 17.2Ohms. Assuming an MRI induced RF voltage at the AIMD input at 64 MHz of10 Volts, the RF current diverted through the X7R capacitor is 10 Voltsdivided by 17 Ohms which is 0.59 Amps. The power dissipation due to theX7R capacitor's ESR (I²R) is (0.59)²(17)=5.88 Watts. This amount ofpower dissipation is very excessive for such a small component and willcause a temperature rise of over 20 degrees C. On the other hand, theNPO capacitor's impedance is equal to −j6.22+1 or Z=6.3 Ohms. This lowerimpedance will result in a much better filter (higher attenuation) andwill drop the RF voltage from 16 Volts to approximately 3.71 Volts. Thisvoltage drop is caused by the lead's characteristic impedance and thefact that more current has been drawn through this impedance. Thiscauses a voltage drop in the lead's characteristic impedance as measuredat the input to the AIMD. The RF current through the NPO capacitor isthen 3.71 Volts divided by 6.3 Ohms which is 0.59-amps. The powerdissipation (I²R) is (0.59 Amps)²(1 Ohm) which equals 0.35 Watts whichwill result in a much smaller temperature rise. Accordingly, the low ESRdiverter capacitor 140 design of the present invention offers thefollowing advantages: (1) it has a much lower impedance at 64 MHz and istherefore a more effective EMI filter, and; (2) because it offers higherattenuation, it therefore acts to reduce the MRI induced RF voltage atthe input to the AIMD; and (3) as will be shown in the presentinvention, the diverter capacitor 140 can be designed to conduct orconvect heat away and dissipate it over a larger surface area.

The capacitor 140 is bonded with an insulating washer 162 to thehermetic terminal 132. An electrical attachment 152 is made using athermal-setting conductive adhesive between the feedthrough capacitoroutside diameter metallization 164 and gold braze surface 158. Thenecessity to make an oxide free attachment between the feedthroughcapacitor 140 and the ferrule 134 is described in U.S. Pat. No.6,765,779. An insulator 156 such as glass or alumina ceramic, ishermetically sealed to the ferrule 134 by means of gold braze 154 a. Thefour leadwires 142 are also hermetically sealed to the insulator 156 viagold braze rings 154 b (there are four of these). The feedthroughcapacitor active electrode plates 144 are attached by co-firing to thecapacitor feedthrough hole inside diameter metallization 166. Conductiveelectrical material 168 is used to attach the metallization 166 to eachone of the leadwires 142.

As previously mentioned, FIG. 17 is a cross-sectional view takengenerally of section 17-17 from FIG. 16, illustrating the feedthroughcapacitor active electrode plate set 144.

FIG. 18 is a cross-sectional view taken generally of section 18-18 fromFIG. 16 and illustrates the ground electrode plate set 146.

Referring once again to FIG. 14, one can see that there are only twoactive electrode plates 144 and two ground electrode plates 146. A lowelectrode plate count is typically the case for prior art filteredfeedthrough (diverter) capacitors 140 used in AIMD applications such ascardiac pacemakers, ICDs and the like. Another reason that thecapacitance value is generally low is that a high capacitance valuewould load down the output of the AIMD. For example, too high of acapacitance value would distort pacemaker therapeutic pulses and alsorob energy from the system. An even more extreme example would be thecase of an implantable cardioverter defibrillator, wherein too high of afilter capacitance value would seriously degrade the high voltagemonophasic or biphasic shock wave form. In the experience of theinventors, the capacitance value for AIMD diverter capacitor 140 is in arelatively narrow range from 10 to 20,000 picofarads. In most cases, thecapacitance value is between 350 and 10,000 picofarads. Having acapacitance value between 350 and 10,000 picofarads effectivelyattenuates most emitters from which AIMDs can be affected. This includesmicrowave ovens, cellular telephones and the like, which typicallyoperate in the GHz frequency range. The thickness 170 of the capacitorhowever, cannot be below a certain minimum or the barium titanate basedceramic capacitor will become too fragile. The entire hermetic terminal132 and the feedthrough capacitor 140 must be able to withstand thermalcycles and shocks including installation by laser welding into the AIMDhousing 124. Accordingly, it is very unusual to see a diverter capacitor140 thickness 170 of less than 20/1000 of an inch. Correspondingly, whenone looks at a typical prior art feedthrough capacitor 140 for humanimplant in cross-section, one sees that there are very few electrodes144, 146 relative to its overall thickness 170. In fact, there areusually a number of blank dielectric (no electrodes) cover sheets 172added on the top and/or bottom of the capacitor 140 consisting ofceramic material which is co-fired to add mechanical strength. However,there is a serious downside to having very few electrode plates 144,146, and that is that the high frequency equivalent series resistance(ESR) of the capacitor increases. For prior art AIMD filter or divertercapacitor 140 having significant dielectric and/or ohmic resistance athigh frequencies simply does not matter. This is because the powerinduced from a typical emitter, such as a cellular telephone ormicrowave oven results in a trivial amount of RF current flowing throughdiverter capacitor 140. Even in the most extreme examples, only a fewmilliwatts of heat would be generated within the capacitor structureitself. However, for high power RF current handling applications, suchas diverting MRI induced RF energy, the capacitor dielectric loss andhigh frequency ESR become critical and must be kept as low as possible.Accordingly, it is a feature of the present invention to have arelatively high number of electrode plates 144, 146 (generally greaterthan 10). However, with a high k barium titanate based ceramicdielectric with a dielectric constant of around 2500, a high number ofelectrode plates would result in a very high (too high) capacitancevalue. A way to solve this is to use a relatively low dielectricconstant material, such as EIA Standard NPO material. NPO material has amuch lower k (generally, in the area of 60 to 90). Accordingly, in orderto achieve the desired capacitance value (in the range of 300 to 3000picofarads), a much greater number of electrode plates is required. Thehigher number of electrode plates creates more parallel paths for RFcurrent flow and greatly reduces the ESR of the feedthrough capacitor.One is referred to the equation illustrated in FIG. 29 to explain therelationship between capacitance and the number of electrode plates andother factors.

FIG. 19 is an exploded view of the interior electrodes of the prior artquadpolar feedthrough capacitor 140 of FIGS. 15-18. The active electrodeplate sets are shown as 144 and the ground electrode plates are shown as146. One or more cover layers 172 are put on the top and bottom foradded electrical installation and mechanical strength. As previouslydescribed, this results in a relatively low number of active electrodeplates 144 and ground electrode plates 146 which results in a relativelyhigh ESR.

FIG. 20 is a schematic diagram of the quad polar feedthrough capacitor140 of FIGS. 13 and 15. Feedthrough capacitors are three-terminaldevices labeled in FIGS. 20 as 141 a, 141 b, and 141 c.

FIG. 21 is a prior art multi layered ceramic capacitor (MLCC) 140′.These are made by the hundreds of millions per day to service consumerelectronics and other markets. Virtually all computers, cell phones andother types of electronic devices have many of these. One can see thatthe MLCC 140′ has a body generally consisting of a high dielectricconstant ceramic 148′ such as barium titanate. It also has a pair ofsolderable termination surfaces 164 a, 164 b at either end. Thesesolderable termination surfaces 164 a, 164 b provide a convenient way tomake a connection to the internal electrode plates 144, 146 of the MLCCcapacitor 140′. FIG. 21 can also take the shape and characteristics of anumber of other types of capacitor technologies, including rectangular,cylindrical, round, tantalum, aluminum electrolytic, stacked film or anyother type of capacitor technology.

FIG. 22 is a sectional view taken from section 22-22 in FIG. 21. TheMLCC 140′ includes a left hand electrode plate set 144 and a right handelectrode plate set 146. One can see that the left hand electrode plateset 146 is electrically connected to the external metallization surface164 a. The opposite, right hand electrode plate set 146 is shownconnected to the external metallization surface 164 b. Prior art MLCC140′ and equivalent chip capacitors are also known as two-terminalcapacitors. That is, there are only two ways electrical energy canconnect to the body of the capacitor. In FIGS. 21 and 22, the firstterminal 174 is on the left side and the second terminal 176 is on theright side. As defined herein, MLCC capacitors are two-terminal devices.In contrast, feedthrough capacitors are three-terminal devices whichhave very low self-inductance and make excellent high frequency EMIfilters.

FIG. 23 is the schematic diagram of the MLCC chip capacitor 140′illustrated in FIGS. 21 and 22.

FIG. 24 illustrates another type of prior art 3-terminal filtercapacitor known as a flat-through capacitor 140″. It is connected ateach end to a circuit trace 178 a, 178 b. A circuit current 180 passesall the way through the capacitor 140″. The capacitor 140″ is alsoconnected to ground circuit paths 182 a, 182 b. The overlap of theactive electrodes and the ground electrodes creates the capacitance.

FIG. 25 illustrates the internal electrode plates of the flat-throughcapacitor 140″ of FIG. 24. A set of ground plates is illustrated as 146.The through electrode plate 144 is connected to capacitor terminationsurfaces 164 a, 164 b.

FIG. 26 illustrates a method of attaching MLCC chip capacitors 140′directly to the hermetic terminal 132. In accordance with the presentinvention, the MLCC capacitors 140′ would be of relatively lowdielectric constant, like NPO such that they will have a high number ofelectrode plates thereby minimizing their ESR. This would make them veryeffective in diverting high levels of RF current at an MRI RF pulsedfrequency. One is referred to U.S. Pat. Nos. 5,896,267 and 5,650,759,both to Hittman et al., which more thoroughly describe the use of MLCCcapacitors as filters attached at or near the hermetic terminal of anactive implantable medical device. These two patents are incorporatedherein by reference.

FIG. 27 is a cross-section of a typical MLCC capacitor 140′, such asthose used in FIGS. 21 and 26 (except that the ESR would be high due tothe low number of electrodes). The principles of this cross-section arealso equally applicable to any type of feedthrough capacitor 140, suchas that described in FIGS. 13 and 15. In general, the equivalent seriesresistance of a capacitor depends upon a number of very importantvariables. The capacitor's ESR is the sum of the connection resistance(R_(c)) 184, the resistance of attachment materials (R_(a)) 186, theresistance of capacitor metallization (used to attach to internalelectrode plates) (R_(m)) 188, the resistance of the electrodes (R_(e))190 and 190′ and also the resistance of the dielectric loss tangent(R_(DL)) 192. There is also another type of resistance (not shown) whichoccurs at very high frequency, known as skin effect (R_(s)). This is asituation in which the bulk of the current flow is on the skin ofelectrodes and circuit connections instead of uniformly distributedthroughout a conductor. This has the affect also of increasing acapacitor's ESR. In general, for typical MRI RF pulsed frequencies, skineffect can be ignored (it's mostly a greater than 500 MHz phenomenon).

FIG. 28 is the schematic diagram from FIG. 27 showing that for thesepurposes, the capacitor's ESR is the sum of the connection resistance(R_(c)) 184, the connection material (R_(a)) 186, the metallization(R_(m)) 188, the electrode plate resistance (R_(e)) 190 and thecapacitor's dielectric loss (R_(DL)) 192. The capacitor's dielectricloss (R_(DL)) 192 is frequency variable, which will be explained infurther detail. For a well designed and properly installed capacitor,many of these resistances are so small that they can be ignored. Forexample, referring once again to FIG. 27, if the capacitor metallization(R_(m)) 188 is well designed and properly attached, it will have atrivially small resistance. In a similar fashion, if the electricalattachment material (R_(a)) 186 is a solder or a proper thermal-settingconductive adhesive, it will also have a trivial amount of resistance.If the system is attached to gold or another similar non-oxidizedsurface, then the connection resistance (R_(c)) 184 would also betrivially small or about zero. Referring once again to FIG. 28, one cansee that the total ohmic losses are R_(o) 200, and in this case, R_(o)consists almost entirely of the total electrode plate resistance(R_(e)(total)) 190. This is why it is so important in the presentinvention to maximize the number of electrode plates. At high frequency,the ohmic loss of the low dielectric constant capacitor is almostentirely due to the resistive loss of the active and ground electrodeplates (R_(e)(total) 190).

FIG. 29 gives the equation relating capacitance to the dielectricconstant k, the active (overlap area) of the electrode plates A, thenumber of electrode plates n and the dielectric thickness d. Since thedielectric constant k is directly related to the capacitance C, one cansee how dramatically the capacitance would rise when the dielectricconstant k is 2500 as opposed to a k below 200 for an EIA Class Idielectric of the present invention. Assuming a constant dielectricthickness d for a particular voltage rating, the only way to increasethe capacitance to its original value, would be to greatly increase thenumber of electrode plates. In the prior art, this would becounterintuitive. However, in the present invention, this is exactlywhat we want to do. A high number of electrode plates drives down thehigh frequency ohmic losses and thereby greatly increases the efficiencyof the capacitor to pull RF energy out of an implanted lead during MRIscans. In addition, the high number of electrode plates has a very lowequivalent series resistance at the MRI RF-pulsed frequency, therebysignificantly reducing the amount of heat that would be produced in thefilter diverter capacitor 140.

FIG. 30 illustrates an ideal capacitor 194 and also a non-idealcapacitor 196 which consists of an ideal capacitor 194 in series withits ESR 198. For the purposes of the present discussion, a capacitor'sseries inductance or insulation resistance (a parallel resistance) canboth be ignored. This is because the inductance of feedthroughcapacitors is quite low at MRI RF-pulsed frequencies. Further, thecapacitor's insulation resistance is generally in the megohms or gigohmsrange, which is so high, it can also be ignored as a parallel path. Alsoshown is a graph of the impedance plane showing the capacitor ESR in thereal axis and the capacitive reactance −jXc shown on the imaginary axis.The capacitor's loss tangent δ is also illustrated.

In FIG. 31, equations are given for capacitive reactance Xc anddissipation factor DF and also for the tangent of δ which is alsodefined as dissipation factor DF. Historically, dissipation factor hasbeen expressed as a percent, such as 2.5% maximum. This would mean thatthe allowable dissipation factor would be 2.5% of the capacitor'scapacitance reactance at a particular frequency. Usually, due todielectric losses, this number is dominated at low frequencies by thecapacitor's dielectric loss. The capacitor's dielectric loss isgenerally related to its dielectric constant and the frequency of thedriving energy. For example, if the frequency of an applied sinusoid isrelatively low (say 60 Hz) then the crystal lattice of the capacitor hasplenty of time to deflect back and forth under the electrical stress andin so doing, produces a significant amount of heat which is a type ofreal or resistive loss. At 1 kHz, the capacitor dielectric structure (ordipoles, if one uses that theory) vibrates at a higher frequency. As onegoes higher and higher in frequency, say to 10 MHz, then for the Class Idielectrics of the present invention, there would be very littlemovement in the crystal lattice and accordingly, very little heatgenerated due to dielectric loss. It will be further illustrated howdielectric loss varies with frequency. In the past, particularly asdescribed by testing specifications such as MIL-Std-202, dissipationfactor is measured either at 1 kHz, or in some cases, at 1 MHz.Unfortunately, this data is misleading at MRI RF-pulsed frequencieswhich generally are 21.28 MHz (0.5 T), 64 MHz (1.5 T) or higher. Formost dielectrics, the high frequency ohmic loss, due to the capacitor'selectrode plates, is so low that it is masked by the capacitor'sdielectric loss when measured at low frequencies such as 1 kHz or 1 MHz.This will be explained in subsequent Figures.

FIG. 32 is a more complete schematic for a capacitor, which has beensimplified from FIG. 28. (R_(o)) represents ohmic loss 200 which is thesum of the connection loss (R_(c)) 184, the attachment materials (R_(a))186, the metallization (R_(m)) 188, and the electrode plate resistance(R_(e)) 190. Assuming that the connection resistance (R_(c)) 184 is verylow, such as in attachment to gold, and that the attachment material(R_(a)) 186 has a very low resistivity, such as a thermal-settingconductive adhesive or a solder, and assuming that the capacitormetallization 188 materials have very little ohmic resistance to theelectrode plates, then one can assume that the bulk of the entire ohmicloss (R_(o)) 200 is equal to the resistance of the electrode stack(R_(e)(total) 190. As previously described, the resistance of theelectrode stack depends on the length, the width and the thickness ofthe electrodes and importantly, also the number of electrodes that arein parallel. Therefore, reducing the dielectric loss and maximizing thenumber of electrodes, are key featured embodiments of the presentinvention.

FIG. 33 is a simplified schematic diagram of the present invention fromFIG. 32 showing that the ESR 198 is the sum of the dielectric loss(R_(DL)) 192 plus the total parallel resistance of the electrode stack(R_(e)) 190. Referring once again to FIG. 32, one can see that there isa resistor (R_(IR)) 202 in parallel with the ideal capacitor C 194. Thisresistance (R_(IR)) 202 is known as the capacitor's insulationresistance. In a high quality capacitor, this resistance value tends tobe in the hundreds of megohms or higher and can therefore be ignored aspart of the equivalent circuit model for the purposes herein. Forthree-terminal or physically small MLCCs, the equivalent seriesinductance (ESL) 204 as shown in FIG. 32 is a very small value and canalso be ignored for the purposed herein. In addition, ESL 204 isimaginary and does not contribute to power loss or ESR 198 in acapacitor.

Accordingly, as shown in FIG. 33, the AIMD diverter capacitor 140′ ESR198 is the sum of the dielectric loss (R_(DL)) 192, the ohmic losses(R_(o)) 200 and any losses due to skin effect (R_(s)) 206. However, atMRI RF frequencies, skin effect is negligible and may be ignored.Referring once again to FIG. 33, assuming that the capacitor has goodmetallization, oxide free connection to the ferrule and good electricalattachment materials, then the ohmic losses (R_(o)) 200 are completelydominated by the resistance of the electrodes (R_(e)(total) 190.Accordingly, for the purposes of the present invention, the ESR 198 isgenerally equal to the dielectric loss 192 plus the electrode losses(R_(e)) 190. Both of these parameters must be carefully controlled forthe high power RF diverter capacitor 140′ of the present invention.

It has been shown that dielectric loss is a frequency variable. At MRIRF pulsed frequencies, for an EIA Class I ceramic capacitor, thedielectric loss drops to a very low value (it is essentially zero).Therefore, in the present invention, which is based on EIA Class Idielectrics, the diverter capacitor's140′ ESR 198 is primarilydetermined by the total resistance of its electrode plates (R_(e)) 190.

FIG. 34 illustrates the dielectric loss in ohms for a relatively lowdielectric constant ceramic capacitor. One can see, at low frequencies,the dielectric loss in ohms can be over 1000 ohms or even much greater.However, as one increases in frequency, one can see that the dielectricloss drops and is nearly zero at 64 MHz (1.5 T MRI scanner RF-pulsedfrequency).

FIG. 35 shows a U-shaped composite curve. It is the summation ofcapacitor ohmic loss which includes the total resistance of capacitorelectrodes, electrical attachment materials, capacitor metallization,and electrical connection material. As one can see, ignoring skineffect, the conductor ohmic loss for the capacitor is relativelyconstant from low frequency all the way to very high frequencies. For aClass I dielectric, the capacitor dielectric loss (marked with smallsquares) is a very high value at low frequency, and then drops to nearzero at MRI RF frequencies such as 64 MHz and 128 MHz. Skin effect isalso shown, which would be an ohmic loss for two-terminal typecapacitors. The total ESR is the solid line, which is the summation ofthe capacitor dielectric loss, the capacitor conductor ohmic loss andskin effect. The present invention is directed to make sure the centerof this U-shaped curve falls on the range of MRI RF-pulsed frequencies.

FIG. 36 is a table showing an example of losses (actually measured) fora prior art 2000 picofarad X7R feedthrough capacitor. This particularcapacitor had a dielectric constant of about 2500. One can see that at 1kHz, the dissipation factor is about 1591.55 ohms, which when added tothe ohmic losses, results in an equivalent series resistance of about1591.98 ohms. Even at 1 MHz for this capacitor, there is about 1.59 ohmsof dissipation factor loss, which when added to the about 0.432 ohms ofohmic loss, yields an ESR of about 2.024 ohms. As one can see, againreferring to MIL-Standard-220 and many other test specifications,measuring the capacitor's real losses, at 1 kHz and 1 MHz, is not auseful way to analyze the capacitor's losses at MRI RF-pulsedfrequencies. For this, one needs to look in the range from 10 to 500 MHzand realize that as the dissipation factor drops, the ohmic losses stilldominate and one ends up with a significant ESR ranging from about 0.591to about 0.434 ohms.

FIG. 37 dramatically illustrates the difference when one uses an EIAClass I dielectric, such as COG (NPO), which has a dielectric constantof less than about 200. Because of this low dielectric constant, one isforced to use a very high number of electrode plates. This has theeffect of greatly reducing the capacitor's ohmic losses. In addition,Class I dielectrics have a lower dissipation factor, particularly athigh frequency. Comparing 100 MHz, one can see for the COG dielectric,the ESR is about 0.201 ohms at 100 MHz, which is a significant reductioncompared to the X7R capacitor. In the preferred embodiment (illustratedin FIGS. 39-93), the ESR would drop to below 0.1 ohms, which wouldresult in a significantly reduced heat generation in the presentinvention diverter capacitor 210.

FIG. 38 is a scan of the capacitor's ESR taken from an Agilent MaterialsAnalyzer. At the start frequency of 1 MHz, one can see that thecapacitor's 210 ESR is on the order of 6 ohms, which is very high.However, by using a EIA Class I dielectric, by the time one reachesabout 21.28 MHz (the frequency of a 0.5 T MRI scanner), the dielectricloss has flattened out (reached about zero). The only loss left is theohmic loss of the capacitor, which at 100 MHz is only 200 milliohms.Also shown are the RF-pulsed frequencies for a 1.5 Tesla scanner (64MHz) and a 3 Tesla scanner (128 MHz).

Since the 1960s it has been a common practice in the capacitor industryto measure capacitance and dissipation factor at 1 kHz. The dissipationfactor is usually defined as a percentage, for example, 2.5% maximum.What this means is that the dielectric loss resistance can be no morethan 2.5% of the capacitive reactance at a certain frequency (usually 1kHz). For example, if the capacitive reactance for a particularcapacitor was 80,000 ohms at 1 kHz with a 2% dissipation factor thiswould equate to 1600 ohms of resistance at 1 kHz. FIG. 38 alsoillustrates that the dielectric loss essentially goes to about zero athigh frequency. For typical low dielectric constant Class 1 ceramiccapacitors, frequencies above 10-20 MHz will be sufficiently high sothat the dielectric loss is no longer a factor in the capacitor ESRmeasurement. In summary, the ESR of the capacitor 210 varies with thecapacitance value, the number of electrode plates, and the length andwidth of the electrode plates. Accordingly, a wide range of “normal” ESRreadings can be obtained for many types of capacitors. For oneparticular capacitor a normal ESR reading might be 0.05 ohms and foranother design as much as 10 ohms.

In the present invention, as shown in the embodiment of FIG. 39,maximization of the number of electrode plates in order to reduce theelectrode resistance (R_(e)) becomes paramount. In general, in order toincrease the number of electrode plates, the effective capacitance area(ECA) can be minimized and the dielectric constant lowered so that oneends up with a relatively high number of electrode plates. One mightask, why doesn't one simply make the electrode plates much thicker inorder to decrease their resistance? It would be true that making theelectrode plates very thick would reduce their resistance; however,there would be an undesirable consequence. The capacitor would no longerbe a monolithic layer and would simply represent a sandwich somewhatlike a deck of cards that is ready to come apart at the first thermalshock or piezoelectric effect. It is a basic tenet of ceramicengineering that electrodes be thin enough, and contain enough ceramicpowder such that when sintered, the ceramic capacitor structure becometruly monolithic. This leaves the designer with only a few effectiveways to control the capacitor's ESR. For a given geometry, which isusually dictated by the AIMD design, there are very few degrees offreedom in the length, width and geometry of capacitor electrode plates.Accordingly, in the present invention, maximizing the number ofelectrode plates becomes a key design factor. This goes hand in handwith the capacitor's dielectric constant k. In other words, reducing thedielectric constant means that the number of capacitor electrode platesmust increase to achieve the same capacitance value. This naturallyreduces the capacitor's ESR and increases its ability to handle highlevels of RF current. Another reason to keep the ESR 198 of the divertercapacitor's 210 extremely low is so it does not overheat while divertinghigh levels of RF current to the EDS housing 124 of the AIMD 100. The RFcurrents are literally conducted through the capacitor's 210 electrodeplates 212, 214 and hence through the electrode plate resistance (R_(e))190. Electrode plate resistance (R_(e)) 190 is the sum total of theresistance of all of the electrode plates 212, 214 acting in parallel.If the electrode plate resistance (R_(e)) 190 were high, then therewould be a tremendous amount of I²R power loss that occurs and thecapacitor 210 would rapidly get very hot and perhaps destroy itselfand/or the surrounding electrical connections or materials. Anotherreason to keep the capacitor 210 ESR 198 relatively low is so that itrepresents a very low impedance Z at the MRI RF pulsed frequency. Thiswill increase its ability to draw energy from the implanted lead 110 anddivert it as an energy dissipating surface to the AIMD housing 124. Ifthe capacitor represented too high of an impedance, this would reducethe current, but would also mean that more energy was undesirably leftin the implanted lead 110. Lowering the impedance Z of the divertercapacitor 210 also means that it will be a better EMI filter by offeringincreased attenuation at the MRI RF pulsed frequency.

FIG. 39 illustrates a cross-section of a multilayer ceramic capacitorMLCC 210 of the present invention which is very similar to the prior artMLCC 140′ illustrated in FIG. 21. FIG. 39 can also be equivalent to anyof the aforementioned feedthrough capacitors. In the present invention,feedthrough capacitors or MLCCs can act as high power RF energydiverters. Energy diverters using an energy dissipation surface 134, 124are more thoroughly described in Published Application Nos. 2010/0217262and 2010/0023000, the contents of which are incorporated herein byreference. The key difference is that the number of electrode plates,both active 212 and ground 214, has been substantially increased inorder to reduce the capacitor's 210 ESR 198 to below 2 ohms. In aparticularly preferred embodiment, the capacitor's ESR 198 would bebelow 1 ohm. As previously mentioned, a way to accomplish this withoutthe capacitance value becoming too high would be to decrease thedielectric constant such that a high number of electrode plates would berequired. In a particularly preferred embodiment, the dielectricmaterial would be an EIA Standard Class I type such as NPO. Referringonce again to FIG. 39, one can see the active (left hand) electrodeplates 212 and the ground electrode plates (right hand) 214 stacked ininterleaved relation. An electrical attachment material 152 is shownwhich connects the capacitor metallization 164, 188 to the ferrule of ahermetic terminal 134. In general, the electrical connection material152 would be highly electrical conductive, but not necessarily highlythermally-conductive. In a preferred embodiment, a highlythermal-conductive overlay material 216 has been added in order toefficiently conduct heat from the capacitor electrode plates 212, 214and terminations 164 a, 164 b to the ferrule 134 and/or lead 142. As anexample, this MLCC capacitor type construction can be mounted to ahermetic terminal 134 as shown in FIG. 26. In summary, the capacitor 210embodied in FIG. 39 is based on an EIA Class I dielectric, which meansits dielectric constant is relatively low and its temperaturecoefficient, as given by standard ANSI/EIA-198-1, published Oct. 29,2002, with reference to Table 2 permissible capacitance change from 25degrees C. (ppm/degree C.) for Class I ceramic dielectrics. Thisindicates that the maximum allowable change varies from +400 to −7112parts per million per degrees centigrade. As previously mentioned, aparticularly preferred embodiment would be the COG dielectric, which isalso commonly referred to as NPO. The thermally-conductive overlaymaterial 216, shown in FIG. 39, is preferred, but optional.

FIG. 40 is an equation showing the effect of the parallel plateresistances. FIG. 40 gives the equation for the total resistance of thecapacitor's electrode plates (R_(e)) 190 as the parallel summation ofall of the capacitors' electrode plates 212, 214 (“n” electrode plates).

FIG. 41 is very similar to the cross-section of the quad polar capacitorpreviously described in FIG. 15. Again, the number of electrode plates212, 214 have been increased in accordance with the present inventionsuch that the FIG. 41 quad polar diverter capacitor 210′ has a highfrequency ESR 198 generally less than 2 ohms. Referring once again toFIG. 41, one can see that the capacitor outside diameter (ground)metallization 164 is attached using a conductive material 152 to a goldsurface 158 on ferrule 134. All of these connections, when properlydone, have negligible resistance. Accordingly, the capacitor's 210′ ESR198, at high frequency, is made up of the total of the resistance(R_(e)) 190 of the ground electrode plates 214 and the resistance(R_(e)) 190′ of the active electrode plates 212 all acting in parallel.As previously stated, for Class I dielectrics, the capacitor'sdielectric loss 192 can be ignored at MRI RF pulsed frequencies since itbecomes negligible at RF-pulsed frequencies. Also, for a feedthroughcapacitor geometry, skin effect 206 is also negligible. Referring onceagain to FIG. 13, one can see a similar rectangular quadpolar capacitorthat is attached to a gold braze surface 158.

FIG. 42 is taken from section 42-42 from FIG. 41 and illustrates adoubling of the capacitor's active 212 and ground 214 electrode plates.Doubling the electrode plates 212, 214 is very effective since bothplates are still exposed to the capacitor's internal electric fields andtherefore, both sets of doubled plates will have electrode platedisplacement currents (RF currents). This has the effect of greatlyincreasing the number of electrode plates as illustrated in the equationin FIG. 40, which significantly reduces the overall electrode plateresistance. Dual electrodes are shown in U.S. Pat. No. 5,978,204 toStevenson el al., the contents of which are incorporated herein byreference. In the '204 patent, the dual electrodes were utilized tofacilitate high pulse currents, for example, in an implantabledefibrillator application. Double electrodes are very useful in thepresent invention to drive down electrode plate resistance, therebydriving down the capacitor's 210′ high frequency ESR 198 and also toincrease the conduction of heat 218 out of the capacitor 210′ duringexposure to high power MRI RF-pulsed environments.

FIG. 43 is very similar to FIG. 42 except in this case, only the groundelectrode plates 214 have been doubled. Increasing the number of groundplates 214 is particularly efficient in the removal of heat. As shown,the ground plates 214 are utilized to conduct heat away from thediverter capacitor 210′ and direct it through the ferrule of thehermetic seal 134 to the housing 124 of the AIMD 100, which has arelatively large surface area. The relatively large surface area of theAIMD 100 means that a great deal of RF or thermal energy can bedissipated without concentrating it in a small location, which wouldlead to a very high temperature rise and possibly damage surroundingbody tissue damage.

FIG. 44 is very similar to FIG. 43 except in this case, three groundelectrode plates 214 are shown. In this case, the third electrode plate214 c (the one sandwiched between the upper 214 a and lower 214 b) wouldnot conduct electrode displacement currents since it's shielded andexposed to the electric fields of the capacitor. However, in someembodiments, this could be a useful structure to conduct additional heat218 away from the capacitor's internal structure. It will be obvious tothose skilled in the art that any number of ground electrode plates,including “n” electrode plates could be used.

FIG. 45 is a sectional view taken from section 45-45 from FIG. 41. Itshows an enlarged cross-section of the thermal-setting conductiveadhesive attachment material 152 that connects the capacitor externalmetallization 164 to the gold braze surface 158 and the ferrule 134. Inthis case, the conductive adhesive 152 filler material consists of roundconductive spheroids 152 a. Also in this case, the spheroids 152 a areall relatively the same size. This is typical of some silver-filledconductive epoxies. However, this is a very inefficient arrangement forthermal-conductivity. The spheroid conductor particles 152 a makecontact at their tangent points only. In this regard, FIG. 45 is not aparticularly preferred embodiment.

FIG. 46 is very similar to FIG. 45 and is taken from section 46-46 ofFIG. 41 and shows that, in this case, the conductive particles 152 bloaded in the thermal-setting conductive adhesive 152 are of variousdiameters. This tends to pack the structure much more tightly (morecontact points) in terms of thermal-conductivity and it's considered animproved embodiment in accordance with the present invention.

FIG. 47 is taken from section 48-48 again of FIG. 41 and shows thatsilver flake or similar flake materials 152 c are used instead ofspheres. These tightly packed flakes 152 c are a particularly preferredembodiment in that they have very low impedance and very highthermal-conductivity.

Another particularly preferred embodiment is shown in FIG. 48 which istaken from section 48-48 of FIG. 41, which illustrates that theconductive fillers 152 d can be rods, tubes, whiskers, fibers, nanoparticles, or other similar materials, alone or in combination, that aidefficient thermal transfer. The preferred embodiment leverages thefiller content with the filler shape and/or type to achieve effectivemultiple point-to-point contact and/or anisotropic dispersions thatfacilitate the thermal conductivity.

FIG. 49 illustrates that any mixture of spheres 152 b as shown in FIG.46, flakes 152 c as shown in FIG. 47, rods or tubes 152 d as shown inFIG. 48, can all be combined together 152 e as shown in FIG. 49. Thesecombinations can be optimized to elicit specific thermal conductivityrates, characteristics, and performance parameters.

As illustrated in FIGS. 46 through 49, these attachment materials 152are both highly electrically conductive and are also highlythermally-conductive. It is a principle of the present invention that,in a preferred embodiment, the electrical attachment material 152 alsohas a thermal-conductivity at 37.degree. C. that is less than 45 wattsper millikelvin. Ceramic filler materials can also be used to aid inthermal-conductivity. However, the problem with this is that addingnon-conductive fillers generally decreases the electrical conductivity.Referring back to FIG. 39, the highly thermally-conductive overlaymaterial 216 could be filled with highly thermally-conductivesubstances, such as ceramics, including alumina nitride (AlN), berylliumoxide (BeO) and the like. All of these materials at 37.degree. C. havethermal conductivities greater than 40 watts per millikelvin. Forexample, beryllium oxide has over 200 watts per millikelvin ofthermal-conductivity at body temperature.

FIG. 50 is very similar to the cross-section of the quadpolar capacitorpreviously described in FIGS. 15 and 41. Again, the number of electrodeplates 212 and 214 have been increased in accordance with the presentinvention such that the FIG. 50 quadpolar diverter capacitor 210′ has anESR 198 generally less than 2 ohms. Referring once again to FIG. 50, onecan see that the capacitor metallization 164 is attached using aconductive material 152 to a gold surface 158. All of these connections,when properly done, have negligible resistance. Accordingly, thecapacitor's ESR 198, at high frequency, is made up of the resistance ofthe ground electrode plates 214 and active electrode plates 212 allacting in parallel. Referring once again to FIG. 50, one can see that anumber of additional ground electrode plates 214′ have been added at thebottom of the capacitor 210′ near the interface with the capacitor 210′and the hermetic seal ferrule 134. These additional ground electrodeplates 214′ are not intended to affect the capacitance of the divertercapacitor 210′. These additional ground electrode plates 214′ greatlyassist in the overall thermal-conductivity of the diverter capacitor210′ thereby diverting heat 218 from the interior of the capacitor 210′through the electrical attachment material 152 (and any supplementalthermally-conductive overlay 216, not shown in this drawing) to theferrule and in turn to the housing 124 of the AIMD 100. The addition ofthese added ground plates 214′ is a novel feature of the presentinvention, which greatly increases the thermal-conductivity of thefiltered diverter capacitor 210′. As previously stated, for EIA Class Idielectrics, the capacitor's dielectric loss 192 is negligible at MRI RFpulsed frequencies.

FIG. 51 is very similar to FIG. 50 except that additional groundelectrode plates 214′ have been added to both the top and the bottom ofthe capacitor 210′ to assist with conductive heat flow 218.

FIG. 52 is also very similar to the cross-section of the quad polarcapacitor previously described in FIGS. 50 and 51. Again, the number ofelectrode plates 212, 214 have been increased in accordance with thepresent invention such that the FIG. 52 quadpolar diverter capacitor210′ has an ESR 198 generally less than 2 ohms. Referring once again toFIG. 52, one can see that a thermally-conductive overlay 216 has beenadded over the top of the feedthrough diverter capacitor 210′ whichprovides additional thermally-conductive paths 218 off the top of thecapacitor, down along its sides and turn to the ferrule 134 and in turnto the conductive housing 124 of the AIMD. One can see the multiple 218path arrows illustrating conductive heat flow away from the dielectricmaterial 148.

FIG. 53 illustrates an embodiment in which highly thermally-conductivematerial 216, 216′ not only overlays the entire capacitor 210′, but alsoextends across a portion of the inside surfaces of the AIMD housing 124.This assists in thermal-conductivity to dissipate the heat 218 out overa larger surface area of the AIMD housing 124.

FIG. 54 is very similar to FIG. 52 except that ground electrode plates214″ have been added inside of the hermetic insulator 156. Theseadditional ground plates 214″ provide added thermal conductive pathswhich assist in conducting heat out of the structure to the ferrule 134and in turn to the AIMD housing 124. In addition, these conductiveground plates 214″ also form a parasitic capacitance 220 between theleads 142 and the electrode plates 214″ which forms an additionalcapacitance. This is a low value of capacitance, but is important indiverting additional high frequency energy away from the leads 142 tothe housing 124 of the AIMD 100.

FIG. 55 is a sectional view taken generally from section 55-55 from FIG.54. This shows a close-up view of the parasitic capacitance 220 whichprovides the additional high frequency filtering.

FIG. 56 illustrates an embodiment in which the diverter capacitor 210′has been moved (flipped over) to the body fluid side. The advantage tothis is that the capacitor is completely exposed so that a highlythermally-conductive sealant or overlay 216 can be placed completelyover and around capacitor 210′ and then extend onto the ferrule 134 andacross all or a portion of the AIMD housing 124. This highlythermally-conductive layer 216 greatly assists in conducting heat 218out of the capacitor 210′ structure as shown by the high number of heatflow arrows 218. In the case where the diverter capacitor 210′ isdisposed towards the body fluid side, it is very important that it beconstructed entirely of non-toxic and biocompatible materials. EMIfilter capacitors designed for direct body fluid exposure are describedin U.S. Pat. No. 7,535,693, the contents of which are incorporatedherein by reference.

FIG. 57 illustrates an embodiment in which a highly thermally-conductiveliner 222 has been added to the inside surfaces of the AIMD housing 124.This highly thermally-conductive liner 222 is preferably in connectionwith the thermally-conductive capacitor overlay material 216. Thissystem greatly aids in heat conduction and heat dissipation over alarger surface area of the AIMD housing 124. Options for high thermalconductivity materials 216, 222 may be used as pure materials or alloysand may include but are not limited to Aluminum, Aluminum Nitride,Beryllium, Copper, Multiwalled Carbon Nanotube, Isotropically EnrichedDiamond, Graphene, Gold, Silver, Platinum, or other materials withthermal conductivity greater than 150 watts per meter Kelvin near 300K.These materials may be used as discrete components to create heatsinking features or as additives to thermoset or thermoplastic resinsystems which can be dispensed to an energy dissipating surface withinthe AIMD. Referring once again to FIG. 57, one can see that additionalground plates 214′ have been added to the top and the bottom of thediverter capacitor structure 210′. This assists in conductive heat flowas shown out through the top and bottom of the capacitor into thesurrounding materials.

FIG. 58 illustrates an embodiment in which a weld shield 224 has beenadded. This weld shield 224 is generally positioned such that it is tackwelded to the ferrule of the hermetic seal 132. As shown, the clamshells of the AIMD housing 124 come together and capture the weld shield224 and the diverter capacitor 210′. The advantage of the weld shield224, in this case, is very similar to what was described in the previousembodiment in which the capacitor 210′ is positioned on the body fluidside. This allows a highly thermally-conductive material 216 to beplaced completely over the capacitor and down over the ferrule 134 andonto the weld shield 224 as shown.

FIG. 59 illustrates a similar capacitor 210′ with additional top andbottom electrode plates 214′ wherein the capacitor's outside diameterand perimeter metallization 164′ has been thickened. In addition, it ismade of highly thermally-conductive materials. Options for high thermalconductivity capacitor 210′ metallization 164′ materials may be used aspure materials or alloys and may include but are not limited toAluminum, Aluminum Nitride, Beryllium, Copper, Multiwalled CarbonNanotube, Isotropically Enriched Diamond, Graphene, Gold, Silver,Platinum, or other materials with thermal conductivity greater than 150watts per meter Kelvin near 300K. These materials may be used asdiscrete components to create heat sinking features or as additives tothermoset or thermoplastic resin systems which can be dispensed to anEDS within the AIMD. The increased thickness and increasedthermal-conductivity of the outside diameter or perimeter metallization164′ greatly assists in increasing the heat flow 218 out of thecapacitor 210′ down to the ferrule 134 and in turn to the AIMD housing124.

FIG. 60 illustrates an embodiment in which the biocompatible aluminaceramic insulator 156 has a co-bonded or sintered layer of a highlythermally-conductive ceramic 226. As shown, this highlythermally-conductive layer 226 assists in conducting heat out of thediverter capacitor 210′-hermetic seal structure 134 to the AIMD housing124.

FIG. 61 illustrates an embodiment in which the upper and lower extraground plates 214′ have been removed and a highly thermally-conductivewasher or layer 228 has been added that is disposed intermediate betweenthe hermetic seal insulator 156 and the diverter capacitor 210′structure. Also shown is an optional insulation washer 162 used forbonding the capacitor 210′ to layer 228. In a preferred embodiment, thisadhesive insulation layer 162 would also be highly thermally conductive.Options for high thermal conductivity materials may be used as purematerials or alloys and may include but are not limited to Aluminum,Aluminum Nitride, Beryllium, Copper, Multiwalled Carbon Nanotube,Isotropically Enriched Diamond, Graphene, Gold, Silver, Platinum, orother materials with thermal conductivity greater than 150 watts permeter Kelvin near 300K. These materials may be used as discretecomponents to create heat sinking features or as additives to thermosetor thermoplastic resin systems which can be dispensed to an EDS withinthe AIMD.

FIG. 62 illustrates a preferred embodiment wherein the divertercapacitor 210′ is embedded completely down inside of ferrule 134. Theentire structure is overlaid with a highly thermally-conductive material222. As shown by the heat arrows 218, this greatly aids thermalconduction out of the diverter capacitor 210′ through the ferrule 134 tothe AIMD housing 124. In a particularly preferred embodiment, the AIMDhousing 124 is generally laser welded and connected somewhat along themidline of the diverter capacitor 210′ to facilitate maximal heatconduction.

FIGS. 63 and 64 illustrate ceramic lowpass diverter capacitor 210′hermetic feedthrough assemblies 132 with a capture flange-style ferrule134 coming part way up the outside diameter or perimeter of saidcapacitor 210′ structure. This capture flange 230 provides a convenientspace around the outside perimeter or circumference 164 of saidcapacitor whereby a robot or automatic dispensing system can dispense athermal-setting conductive material 152 such as a conductive polyimide,solder paste, solder preform or braze preform. The capture flange 230may be positioned higher up around the perimeter or outside diameter 164of the diverter capacitor 210′ as shown in FIG. 64. In this embodiment,one can greatly increase the heat flow 218 from the diverter capacitor210′ to the ferrule 134 and in turn to the AIMD housing 124.

Another embodiment shown in FIG. 65, illustrates the top view of thequadpolar capacitor shown in FIG. 64. In this embodiment, electricalconnections 152 are positioned between the capacitor outside diametermetallization 164 and the ferrule 134. These electrical attachment areas152 are not continuous. Preferably, these electrical attachment areas152 are broken up by areas of attachment to a highlythermally-conductive material 232. This achieves a good balance betweena low impedance and a low ohmic electrical connection and a highlythermally-conductive connection from the capacitor outside diameter 164to the surrounding ferrule 134 and, in turn, to the AIMD housing 124.Options for high thermal conductivity materials 232 may be used as purematerials or alloys and may include but are not limited to Aluminum,Aluminum Nitride, Beryllium, Copper, Multiwalled Carbon Nanotube,Isotropically Enriched Diamond, Graphene, Gold, Silver, Platinum, orother materials with thermal conductivity greater than 150 watts permeter Kelvin near 300K. These materials may be used as discretecomponents to create heat sinking features or as additives to thermosetor thermoplastic resin systems which can be dispensed to an EDS withinthe AIMD.

FIG. 66 is very similar to FIGS. 63 and 64 except that heat convectionfins 234 have been added around the outside diameter metallization 164of the capacitor 210′. It will be obvious to those skilled in the artthat similar fins 234 could be added around a rectangular feedthroughdiverter capacitor 140 as previously illustrated in FIG. 13. These fins234 convect heat 218 a into the interior of the AIMD 100, which in theprior art is generally back-filled with nitrogen, a combination ofnitrogen and helium or even argon.

FIG. 67 is a cross-sectional view taken generally from section 67-67 ofFIG. 66. FIG. 67 illustrates the convective heat 218 a that wouldradiate off the surface of the fins 234. In a preferred embodiment, thefins 234 would be constructed of a highly thermally-conductive material,such as aluminum in order to radiate and dissipate maximal heat 218 ainto the interior atmosphere of the AIMD housing 124.

FIG. 68 is very similar to FIG. 67 except that the heat convection fins234 are associated with a hermetic seal ferrule 134 which does not havea capture flange. In this case, the heat conduction fins 234 are locatedabove the surface of the ferrule 134. The heat conduction fins 234perform the same heat convection purpose as previously illustrated inFIG. 67. Extra ground plates 214′ co-operate with the fins 234 totransfer additional heat out of capacitor 210′.

FIG. 69 illustrates a cross sectional view of an embodiment of an AIMDhousing 124 comprising a hermetic seal subassembly 132, a fill tube 236with a central opening 238 and a ball 240 welded, i.e., laser welded 241therein. The AIMD of this embodiment facilitates back-filling of theinside 124 a of the AIMD housing 124 with a liquid or dielectric gas 242as illustrated in FIG. 70. Filling active implantable medical deviceswith a dielectric fluid 242 is more thoroughly described in U.S. PatentPublication No. 2009/0312835, the contents of which are incorporated byreference. This dielectric liquid 242 can also be a gas at an elevatedpressure. Optionally, an elevated pressure gas fills the insidehermetically sealed area inside the AIMD housing 124. Referring again toFIG. 69, a vacuum is applied at an elevated temperature to the entireassembly to evacuate all moisture, air and other gas molecules from theinside of the AIMD housing 124. At this time, under hard vacuum, thevacuum is broken and a fluid 242 is flooded over the entire assembly.The fluid may include a liquid or a gas, such as a dielectric gas 242.Then a high pressure nitrogen is placed on top of the liquid, whichimpregnates the inside of the entire AIMD housing 124 with the liquid orgas. This is best illustrated in FIG. 70 wherein, the liquid or gas 242fills every crevice in unoccupied space within the interior of the AIMDhousing 124. In a preferred embodiment, the liquid or gas 242 is highlythermally-conductive such that it conducts heat away from thefeedthrough capacitor (not shown), which is located directly underneaththe hermetically sealed housing 132. In a particularly preferredembodiment, the diverter capacitor 210′ has fins 234 as previouslyillustrated in FIG. 66. These fins 234 are designed to efficientlyconvect heat to the liquid or gas 242 that fills the entire insidespaces of the AIMD housing 124. In addition, the atmospheric pressure ofa gas could be increased within an AIMD housing. Gases typically used tobackfill AIMDs could be utilized to increase the atmospheric pressurewithin the device. For example, nitrogen could be used to pressurize thedevice. An increase of about two atmospheres would convect more heataway from the diverter capacitor 210′. As shown, in this case, the thinAIMD housing 124 would deflect slightly outward as shown in 244 and244′.

FIG. 71 is a flow chart illustrating the process as previously describedin FIGS. 69 and 70. After the electronics of the AIMD are sealed in ahousing 124 having an open fill tube 236, the first step 302 of theprocess is to place the AIMD 100 having an open fill tube 236 into avacuum chamber 246. A lid 248 is placed and sealed 304 on the vacuumchamber 246 and a vacuum 306 is pulled for a number of hours on an AIMD.Optionally this process is performed at an elevated temperature. After asuitable time, under hard vacuum, a reservoir of dielectric fluid 250 isintroduced and backfilled 308 into the chamber. Pressurized inert gas252, such as nitrogen, is introduced 310 on top of the dielectric fluid.The inert gas 252 drives or impregnates the dielectric fluid into theinterior spaces of the AIMD. Pressure is slowly released 312 and the lid248 of the vacuum chamber 246 is removed 314. At this point, the ball240 is inserted into a fill tube 236 or a similar fill hole is closed bylaser welding 241 and the like, which hermetically seals the AIMD 100.At this time, the AIMD is removed 316 from the fluid or dielectric gasat which time the welding operation 318 is completed.

FIG. 72 is a cross-sectional view illustrating a diverter capacitor 210′attached to a hermetic seal assembly 132 comprising an insulator 156 anda ferrule 134 a. In this case, ferrule 134 a is a highlythermally-conductive metal, which has been co-bonded to a typicaltitanium ferrule 134. Ferrule 134 a may be fabricated by a powder,metallurgy or metal pressing process or the like. The purpose here is toincrease the heat flow out of the diverter capacitor 210′ duringexposure to a high power MRI RF field. The titanium ferrule 134 or othersimilar biocompatible material, is preferably directed toward the bodyfluid side. The biocompatible properties of the material enables theferrule 134 a to be exposed to body tissues for long periods of time.

As shown in FIG. 73, the diverter capacitor 210′ is designed forelectrical attachment using a ball grid array (BGA) attached method. Inthis case, the hermetic seal insulator 156 has a crimp post with a padfor convenient BGA 254 mounting of the capacitor 210′ as disclosed inU.S. provisional application Ser. Nos. 61/473,188; 61/587,029;61/587,287 and 61/587,373, the contents of which are incorporated hereinby reference.

FIG. 73 illustrates an embodiment in which two different ferrulestructures 134 and 134 a have been co-joined. Preferred joiningprocesses include but are not limited to as brazing, laser welding 256or similar attachment process. In accordance with the present invention,ferrule 134 a comprises a highly thermally-conductive material designedto transfer heat energy out of the diverter capacitor 210′ into theinterior of the AIMD housing 124. In a preferred embodiment, ferrule 134a comprises heat convection fins similar to those illustrated in FIG.66.

FIG. 74 illustrates an embodiment in which a quad polar divertercapacitor 210′ of the present invention attached to the ferrule 134 of ahermetic seal assembly 132 of an AIMD.

FIGS. 75A and 75B illustrate embodiments of electrical attachment areas152. As illustrated, the electrical attachment areas extend from theground electrode plates 214 and/or the active electrode plates 212. Inparticular, the attachment 152 extending from the ground electrodeplates 214 as shown in FIG. 75A resides over a relatively smallattachment area and enables a relatively high frequency ESR.

FIGS. 76A and 76B illustrate embodiments in which the electricalattachment area 152 has been greatly increased. An increased electricalattachment area 152 improves the high frequency ESR of the inline quadpolar feedthrough capacitor 210′. In terms of electrical attachment, asuperior attachment 152 is shown in FIG. 77A where there is a 100% orfull perimeter ground attachment to the capacitor ground electrode plate214. However, this is not necessarily for the diverter capacitor 210′ ofthe present invention to achieve optimal high RF power handling.

FIG. 78A illustrates a hybrid approach comprising an electricalattachment 152 and a highly thermally-conductive attachment 232. In thisembodiment capacitor 210′ has a relatively low ESR due to a goodelectrical attachment 152 plus a very highly efficient thermal transferof heat energy out of the diverter capacitor. The transfer of thermalenergy is achieved through the use of a thermally conductive adhesive232.

FIG. 79 illustrates a family of lowpass filters 260 that all incorporatediverter capacitors 210 of the present invention. As can be seen, theselowpass filters 260 incorporate a variety of capacitors 210 ranging froma simple MLCC chip capacitor “C” to a 3-terminal “feedthroughcapacitor-FTC”. These capacitors 210 can be combined in various wayswith inductors to form “L,” “reverse L,” “T,” “Pi,” “LL,” or “reverseLL” or “n-element” lowpass filters. In other words, any of the highpower RF handling diverter capacitors of the present invention can becombined with any of the lowpass filter circuits as illustrated in FIG.79 for the purpose of protecting AIMD electronics from EMI while at thesame time pulling MRI induced energy from an implanted lead.

FIG. 80 illustrates an electrical schematic comprising a bandstop filter258. As illustrated, the band stop filter 258 may be electricallycoupled to any circuit trace of a medical device within the interior ofthe AIMD housing 124. Furthermore, the band stop filter 258 may beelectrically coupled to any of the lowpass filter circuits 260 aspreviously described in FIG. 79.

FIG. 81 illustrates an L-C trap filter 262 that can be incorporated toany of the circuits illustrated in FIG. 79 or FIG. 80.

FIG. 82 illustrates an electrical schematic embodying an AIMD in whichthe leads enter the AIMD at a hermetic seal 132 and then encounter anyof the lowpass filter elements 260 as described in FIG. 79. In turn,there is a bandstop filter 258 and then an L-C trap filter 262 betweenthe circuit trace and the AIMD housing 124. The AIMD housing 124 acts asa heat 218 a or energy dissipating surface.

FIG. 83 is similar to FIG. 82 except in this case, the general lowpassfilter 260 is in its simplest form. In this case, the general lowpassfilter 260 is a feedthrough capacitor 210′ which is in turn, connectedin series with a bandstop filter 258 which is in turn connected with anL-C trap filter 262 disposed between the circuit trace or lead wire andthe AIMD housing 124.

FIG. 84 shows a dual chamber bipolar cardiac pacemaker 100C with leadsimplanted into the right atrium and right ventricle of the heart 112. Asshown, header block 138 comprises industry standard IS-1 connectors 126,128. MRI energy is shown being induced on the implanted leads 110 and110′. As this energy enters the pacemaker housing 124, it encountersdiverter capacitor 210′. The diverter capacitor 210′ is designed todissipate high RF power in accordance with the present invention.Accordingly, diverter capacitor 210′ has a low dielectric loss at highfrequency and also very low high frequency ESR. In addition, it may haveany one of the aforementioned heat dissipating structures described. Inthis case, there is a secondary row of MLCC chip capacitors 210 athrough 210 d that are mounted at a location distant from the primarydiverter capacitor 210′. In this case, the primary diverter capacitorcould have a lower capacitance value and the rest of the capacitance iscomprised of either board mounted capacitors 210 a through 210 d or thelike. As shown, the circuit board comprises a ground circuit trace 182that is connected through a low impedance RF conductor or strap 264.This low impedance is important to conduct MRI RF currents efficientlyto the housing 124 of the AIMD. In order to spread out heat, multiplestraps 264 can be used (not shown). A major advantage of the structureshown in FIG. 84 is that by spreading out the filtering function, RFheat or MRI RF energy induced heat is dissipated or spread out over muchlarger areas. This avoids hot spots on the AIMD housing 124.

FIG. 85 shows an alternative embodiment to FIG. 84. A circuit board andchip capacitors 210 a through 210 d as previously described in FIG. 84are shown. However in this embodiment, the grounded circuit trace 182does not need a ground strap or conductor 264 to the AIMD housing.Instead, a shielded conduit assembly 266 is attached to the ferrule ofthe hermetic terminal (not shown). This shielded conduit 266 is groundedwith a strap 268 which is connected to the ground circuit trace 182.This type of EMI shielded conduit assembly is more thoroughly describedin U.S. Pat. No. 8,095,224 to Truex et al., the contents of which areincorporated herein by reference.

FIG. 86 shows a cross-sectional view of a flex cable or circuit board270. The flex cable or circuit board 270 is attached on the left using aball grid array (BGA) type attachment 254. Attachment 254 is furtherconnected to a conductor 142 that goes through a hermetic seal 132 of anAIMD (not shown). These types of flexible circuit traces or substratesare also described in U.S. Pat. No. 8,095,224 to Truex et al., thecontents of which are incorporated herein by reference.

FIG. 87 shows a cross sectional view generally taken from section 87-87of FIG. 86 and shows the conductive circuit traces 178 a through 178 d.

FIG. 88 illustrates a cross sectional view generally taken from section88-88 of FIG. 86 and shows an optional embodiment wherein a groundshield 182 surrounds the four circuit traces 178 a through 178 d.

FIG. 89 is a cross sectional view taken generally from section 89-89 ofFIG. 86 and illustrates shield layers 272 a, 272 b. These shield layers272 a, 272 b are designed to surround each of the circuit trace layers178 as previously described in FIG. 87 or 88. These shields 272 a, 272 bare not absolutely required, but greatly assist in preventingre-radiation of electromagnetic interference inside of the AIMD housing124. This re-radiation of EMI can be very dangerous as it can couple tosensitive AIMD circuits and disrupt the proper functioning of the AIMD.

FIG. 90 illustrates an embodiment in which the circuit traces 178 athrough 178 d of FIGS. 86 through 89 are connected to a circuit board orsubstrate 270. Electrical attachments 274 are made to active circuittraces and in turn to a multi-element flat-through diverter capacitor210. This three-terminal flat-through capacitor is very similar to thatpreviously described in FIGS. 24 and 25 except that it has fourcapacitors embedded in a single structure. Capacitor 210 may replace theindividual capacitor 210 a through 210 d as previously illustrated inFIG. 84 or capacitors 210 a through 210 d as previously described inFIG. 85.

FIG. 91 shows a top view of the flat-through diverter capacitor 210 ofFIG.

FIG. 92 is a cross sectional view taken generally from section 92-92 ofFIG. 90 and shows the active electrode plates 212 of the flat-throughdiverter capacitor 219 of FIG. 90.

FIG. 93 is a cross sectional view taken generally from section 93-93 ofFIG. 90 and shows the ground electrode plate 214 set of the flat-throughcapacitor 210 of FIG. 90.

Accordingly, from all of the foregoing it will be appreciated that thisinvention addresses the problems created when the radio frequency (RF)pulsed field of MRI couples to an implanted lead in such a way thatelectromagnetic forces (EMFs), voltages and current are induced in thelead. The amount of energy that is induced is related to a number ofcomplex factors, but in general, is dependent upon the local electricfield that is tangent to the lead and the integral electric fieldstrength along the lead. In certain situations, these EMFs can causecurrents to flow into distal electrodes or in the electrode interfacewith body tissue. It has been documented that when this current becomesexcessive, that overheating of the lead or its associated electrodes canoccur. In addition, overheating of the associated interface with bodytissue can also occur.

There have been cases of overheated electrode damage to cardiac tissuewhich has resulted in loss of capture of cardiac pacemaking pulses.Furthermore, with respect to neurostimulators, neurological tissuedamage severe enough to result in brain damage or multiple limbamputations have also been documented.

The present invention relates generally to methods and apparatus forredirecting RF energy to locations other than the distal tipelectrode-to-tissue interface. In addition, the present inventionprovides electromagnetic interference (EMI) protection to sensitiveactive implantable medical device (AIMD) electronics. The redirection ofthis RF energy is generally achieved by the use of frequency selectivedevices, such as inductors, capacitors and filtered networks. Asdescribed in U.S. Pat. No. 7,689,288, to Stevenson et al., the contentsof which are incorporated herein by reference, filtered energydissipation networks can range from a single capacitor, such as afeedthrough capacitor, to more complex filters that may include L-Ctraps and/or L-C bandstop filters co-operating in various ways with C,L, Pi, T or n-element lowpass filters. In general, this is accomplishedthrough frequency selective lowpass filters or series resonant LC trapfilters wherein the RF energy can be redirected to another surface or isconverted to heat. In all of the above described frequency selectivenetworks, it is the capacitor(s) (co-operating with other circuitelements) which divert energy from an implantable lead system to theconductive housing of an AIMD. The relatively large surface area of theAIMD housing acts as an energy dissipating surface (EDS) wherein asignificant amount of the MRI energy can be harmlessly dissipatedwithout significant temperature rise. However, the lowpass filter alsoknown as diverter capacitor elements must be designed to handle a veryhigh amount of RF current and power. Accordingly, the capacitor'sinternal resistive or real losses known as equivalent series resistance(ESR) must be kept quite low. The present invention is directed tovarious embodiments of MRI diverter capacitor designs that minimize thediverter capacitor's equivalent series resistance (ESR). In addition,the capacitor is also designed to direct heat to relatively largesurface area heat dissipation surfaces, thereby creating an efficientheat removal system. These high RF power/low ESR diverter capacitors arean important feature of the filter network of the present invention fordiverting induced RF energy from an implanted lead to an energydissipating surface, particularly a conductive housing of an AIMD.

These implantable lead systems are generally associated with AIMDs, suchas cardiac pacemakers, cardioverter defibrillators, neurostimulators andthe like. The present invention can also be incorporated with externaldevices, such as external pacemakers, externally worn neurostimulators(such as pain control spinal cord stimulators) and the like. It will beshown that for a given geometry constraint, a preferred means ofreducing the diverter capacitor's ESR is to select the most idealdielectric type so that its dielectric loss tangent (dielectric losses)is insignificant at the MRI RF pulsed frequency(ies). Of particularimportance in the present invention is selection of a capacitordielectric with the proper dielectric constant (k) value. The preferredcapacitor dielectric will have a k of a sufficiently low value tothereby increase the number of active and ground electrode plates in thecapacitor. This design feature dramatically reduces the ohmic losses inthe capacitor at high frequency. Therefore, to accomplish a relativelyhigh electrode plate count, a low k capacitor dielectric is used. Anon-limiting example of one such dielectric material is an EIA standard,Class I dielectric material, COG, which is also known as NPO(negative-positive-zero). (Refer to EIA Standard ANSI/EIA-198-1-F-2002).

In general, at first glance, using a Class I dielectric iscounterintuitive. For example, consider a typical X7R MLCC dielectric,with a dielectric constant of around 2500. With such a high efficiencydielectric material having a relatively high dielectric constant, itwould be possible to build, for example, a 1000 picofarad filtercapacitor with two to four electrode plates. Now consider using a Class1 COG dielectric, wherein the dielectric constant is less than 100. Atypical capacitor comprising the COG dielectric material would generallyrequire greater than 20 or even 40 electrode plates to achieve the samecapacitance value. Such a design would, however, provide a capacitorwith a relatively large thickness and would also require significantlymore precious metal in its manufacturing. A capacitor of this design isgenerally not desired.

Nonetheless, the benefit of incorporating a COG dielectric materialwithin the capacitor design is generally a reduction of the capacitor'sESR at MRI RF-pulsed frequencies. If designed properly, the RF energyheat that is produced when positioned within an MRI scanner can besignificantly reduced such that heat that results from RF energy doesnot pose harm to biological tissue.

One purpose of these low ESR diverter capacitors and related lowpassfilter circuits is to provide electromagnetic interference (EMI)filtering in order to protect sensitive AIMD electronic circuits frommalfunctioning in the presence of MRI RF noise. Another purpose of thesecircuits, as described in the present invention, is to draw MRI inducedenergy out of the lead and redirect said energy to the AIMD housing.This has the effect of reducing the energy that would reach the distaltip electrode or the interface with body tissue. By redirecting saidenergy to locations at a point distant from the distal electrodes,ideally the AIMD housing, this minimizes or eliminates hazardsassociated with overheating of said distal electrodes during diagnosticprocedures, such as MRI.

For maximum RF energy transfer out of the lead, frequency selectivediverter circuits are needed which decouple and transfer energy which isinduced onto implanted leads from the MRI pulsed RF field to an energydissipating surface. Importantly, while decoupling and transferring suchenergy, it is extremely important that the diverter circuits do notthemselves overheat thereby creating hot spots on the AIMD housing,which could damage tissue, for example, in a pacemaker pectoral pocket.Recent experiments by the inventors have seen temperature rises from 4to 10 degrees C. on the pacemaker housing directly over the location ofthe feedthrough capacitor during a 4 watt/kilogram MRI scan. In general,in the prior art, MLCC capacitors are really not indicated for highpower RF applications. The reason for this is that the impedance(capacitive reactance) drops so low that extremely high RF currents endup flowing through the capacitor's electrode plates. During a 4watt/kilogram MRI scan where 16 to 20 volts may be induced at the AIMDinput, the diverter capacitor may be handling anywhere from 0.5 to 4amps of RF current. If the ESR of the capacitor, for example, was 0.5ohms and the capacitor was diverting 2 amps, then the I²R loss would beon the order of 2 watts. Two watts of dissipation on this smallcomponent would cause it to overheat significantly. The presentinvention fulfills these needs and provides other related advantages.

The RF diverting circuits, in general, conduct MRI induced RF energyfrom the lead or its associated lead wires to an EDS such as the housingof the AIMD. The design of the diverter circuit is very important. Firstof all, the diverter circuit should appear as a very low impedance atMRI RF frequencies such that a maximum amount of RF energy is divertedfrom the lead to the EDS. In addition, it is also desirable that thediverter element be designed such that it does not overheat. It has beenshown, through modeling and measurements, that the MRI induced RF energyat the point of input to an AIMD, such as a cardiac pacemaker, can rangefrom about 16 to about 50 volts at about 64 MHz. Assuming an RF inputvoltage of 20 volts and the impedance of the diverter element capacitoris around 4 ohms, this means that about 5 amps of RF current would beflowing through said diverter element. Therefore, its ESR must be quitelow so that it does not overheat. It can be readily seen that such ahigh value of ESR associated with a higher current would quickly resultin failure of the component or other damage. On the other hand, if thediverter capacitor's ESR was 100 milliohms and the RF current that itwas handling was 2 amps, then the power dissipated in the same examplewould be only 0.4 watts. Even 0.4 watts will still create a significanttemperature rise on the diverter capacitor component. The presentinvention describes ways of either conducting or convecting that heataway so that it does not create a hot spot on the AIMD housing.

For a particular AIMD, the geometry of the diverter capacitor is usuallyconstrained by the AIMD design generally comprising, circuit topology,size, and weight considerations. For AIMDs, the filter capacitance valuein picofarads is heavily constrained by the application of its use. Forexample, too high of a capacitance value will tend to load down anddistort therapeutic wave forms. In addition, too high of a filtercapacitance value can distort pacemaker pulses or seriously degrade ICDhigh voltage pulse discharges. In the experience of the inventors,capacitance values for EMI lowpass filter capacitors typically rangefrom about 10 picofarads to as high as about 20,000 picofarads. Forpacemakers, capacitance values as low as about 350 picofarads to as highas 10,000 picofarads are generally used. For monolithic ceramiccapacitors, which tend to comprise dielectric materials having very highdielectric constants, these capacitance values are generally very low.In many prior art designs, only a very few (less than 10) electrodeplates are required. In many designs using typical EIA Standard X7Rdielectrics, there are only two or three electrode plates required.However, these prior art capacitor designs comprising a relatively lownumber of electrode plates, generally of 10 or less, result in acapacitor having significantly high electrode plate resistance of about0.5 ohms or more. Such a capacitor with a relatively high electrodeplate resistance, results in the generation of a great deal of heat asthe capacitor diverts MRI RF-pulsed frequencies, which is not desirable.

Furthermore the mounting location of the diverter capacitor within anAIMD is also typically constrained by proper EMI design practices.Generally, EMI filters are designed such that undesirable RF energy isdiverted at the point of lead ingress to the AIMD housing, as opposed toletting the EMI inside the AIMD housing and trying to filter it furtherdownstream, such as on an internal circuit board. In a preferredembodiment, at least one of the low ESR diverter capacitors of thepresent invention is mounted directly to the multi-pin hermetic sealterminal of the AIMD. This is an ideal location both to divert RF energybefore it can enter the AIMD housing but is also optimal for heatconduction and dissipation. Even with low ESR, the diverter capacitorwill still be dissipating a significant amount of energy. This means,even with low ESR, the diverter capacitor is creating heat which must beconducted or convected away so that a hot spot does not occur on theAIMD housing at or near the filter capacitor. Therefore, by divertingboth the RF energy and heat to the relatively large surface area of thehousing of the AIMD the MRI RF energy can be dissipated with only asmall temperature rise that does not adversely affect body tissue.Although the present invention has applicability to medical devices itis contemplated that it can be utilized in nonmedical applications. Thehigh power filtered feedthough capacitor assembly of the presentinvention is an EMI filter that is applicable to a wide array ofcommercial, military and space applications wherein a shielded enclosuremust pass through leadwires in non-conductive relation to electronicscircuits inside the enclosure. In this case, the pass through may be aninsulator that is hermetic or non-hermetic. This is an importantapplication of the present invention to military “black boxes” that maybe in close proximity to a high RF power source such as an RFtransmitter, radar, or the like.

Although several embodiments of the invention have been described indetail for purposes of illustration, various modifications of each maybe made without departing from the spirit and scope of the invention.Accordingly, the invention is not to be limited, except as by theappended claims.

What is claimed is:
 1. An EMI broadband lowpass filtered hermeticallysealed feedthrough assembly for an active implantable medical device,the feedthrough assembly including at least one capacitor configured forhandling high power by a low equivalent series resistance (ESR), thefeedthrough assembly comprising: a) a conductive ferrule; b) aninsulator hermetically sealed to the conductive ferrule; c) a conductorhermetically sealed and disposed through the insulator between a bodyfluid side and a device side and in a non-conductive relation with theconductive ferrule; d) a broadband lowpass capacitor disposed on thedevice side and configured to be installed inside an electromagneticallyshielded and hermetic conductive housing of an active implantablemedical device, the capacitor comprising a first and second endmetallization, wherein the first end metallization is connected to atleast ten active electrode plates and wherein the second endmetallization is connected to at least ten ground electrode plates,wherein the at least ten active electrode plates are interleaved anddisposed parallel to the at least ten ground electrode plates in acapacitor dielectric, wherein the capacitor dielectric has a dielectricconstant of less than 200; e) an active electrical connectionelectrically coupling the first end metallization to the conductor; andf) a ground electrical connection electrically coupling the second endmetallization to the conductive ferrule; g) wherein the capacitorcomprises: i) a temperature coefficient of capacitance between plus 400to minus 7112 parts per million per degree centigrade (ppm/° C); ii) acapacitance of between 10 and 20,000 picofarads; iii) wherein ESR is thesum of a dielectric loss plus an ohmic loss, and the capacitor comprisesa dielectric loss tangent measured in ohms at an MRI RF pulsed frequencyor range of frequencies that is less than five percent of thecapacitor's ESR; and iv) wherein the capacitor's ESR at the MRI RFpulsed frequency or range of frequencies is less than 2.0 ohms; and h)wherein the conductive ferrule is configured to be disposed into anopening of the housing for an active implantable medical device.
 2. Thefeedthrough assembly of claim 1, wherein the MRI RF pulsed frequency orrange of frequencies comprises 64 MHz or 128 MHz.
 3. The feedthroughassembly of claim 1, wherein the capacitance is between 350 and 10,000picofarads.
 4. The feedthrough assembly of claim 1, wherein capacitor'sESR at the MRI RF pulsed frequency or frequencies is less than 0.5 ohms.5. The feedthrough assembly of claim 1, wherein the capacitor's ESR atthe MRI RF pulsed frequency or range of frequencies is less than 0.1ohms.
 6. The feedthrough assembly of claim 1, wherein the dielectricconstant is less than
 90. 7. The feedthrough assembly of claim 1,wherein the dielectric constant is less than
 60. 8. The feedthroughassembly of claim 1, including an insulative washer between thecapacitor and the insulator.
 9. The feedthrough assembly of claim 1,wherein the second electrical connection comprises a noble metaloxide-resistant attachment.
 10. The feedthrough assembly of claim 9,wherein the noble metal, oxide-resistant attachment comprises a goldbraze.
 11. The feedthrough assembly of claim 1, wherein the capacitor isselected from the group consisting of a monolithic ceramic capacitor, aflat-through capacitor, a chip capacitor, an X2Y attenuator, and afeedthrough capacitor.
 12. The feedthrough assembly of claim 11,including a circuit board disposed on the device side, wherein thecapacitor is mounted to the circuit board and the circuit board ismounted to the ferrule.
 13. The feedthrough assembly of claim 1, whereinthe capacitor comprises an element of a multielement broadband lowpassfilter having at least one inductor, the multielement broadband lowpassfilter forming one of the group consisting of an L filter, a reverse Lfilter, an LL, a reverse LL, a T, a Pi, and an n-element lowpass filter.14. The feedthrough assembly of claim 1, wherein the ferrule comprisestitanium.
 15. A feedthrough assembly, comprising: a) a conductiveferrule configured to be disposed into an opening of a conductivehousing for an active implantable medical device, the ferrule comprisinga ferrule sidewall providing a inner ferrule surface, the ferrulesidewall extending from a device side ferrule end to a body-fluidferrule end; b) an insulator of electrically non-conductive materialcomprising an insulator sidewall having an outer insulator surfaceextending from a device side insulator end to a body-fluid insulatorend, wherein the insulator has at least one terminal pin passagewayextending through and to the device side and body-fluid insulator endsand wherein the outer insulator surface is hermetically sealed to theinner ferrule surface; c) a conductor hermetically sealed and disposedthrough the insulator passageway in a non-conductive relation with theconductive ferrule, wherein the conductor has a length extendingoutwardly beyond the body-fluid insulator end and the device sideinsulator end; d) a capacitor as a passive component lowpass filterdisposed on the device side ferrule end, the capacitor comprising: i) adielectric body supporting at least ten active electrode platesinterleaved with at least ten ground electrode plates; ii) an activemetallization electrically connected to the at least ten activeelectrode plates; iii) a ground metallization electrically connected tothe at least ten ground electrode plates, iv) wherein the dielectric hasa dielectric constant less than 200; e) a first electrical pathwayelectrically coupling the active metallization to the conductor; and f)a second electrical pathway electrically coupling the groundmetallization to the conductive ferrule or the housing of the activeimplantable medical device; and g) wherein the capacitor is configuredfor diverting MRI RF pulsed frequency signals induced on the conductorthrough a low equivalent series resistance (ESR) connection to a housingfor an active implantable medical device, the capacitor comprising: i) atemperature coefficient of capacitance between plus 400 to minus 7112parts per million per degree centigrade (ppm/° C); ii) a capacitance ofbetween 10 and 20,000 picofarads; iii) wherein ESB is the sum of adielectric loss plus an ohmic loss, and the capacitor comprises adielectric loss tangent measured in ohms at an MRI RF pulsed frequencyor range of frequencies that is less than five percent of thecapacitor's ESR; and iv) wherein the capacitor's ESR at the MRI RFpulsed frequency or range of frequencies is less than 2.0 ohms.
 16. Thefeedthrough assembly of claim 15, wherein the MRI RF pulsed frequency orrange of frequencies comprises 64 MHz or 128 MHz.
 17. The feedthroughassembly of claim 15, wherein the capacitance is between 350 and 10,000picofarads.
 18. The feedthrough assembly of claim 15, wherein thecapacitor's equivalent series resistance (ESR) at the MRI RF pulsedfrequency or range of frequencies is less than 0.5 ohms.
 19. Thefeedthrough assembly of claim 15, wherein the capacitor's equivalentseries resistance (ESR) at the MRI RF pulsed frequency or range offrequencies is less than 0.1 ohms.
 20. The feedthrough assembly of claim15, wherein the dielectric constant is less than
 90. 21. The feedthroughassembly of claim 15, wherein the capacitor is selected from the groupconsisting of a monolithic ceramic capacitor, a flat-through capacitor,a multi-element flat through diverter capacitor, a chip capacitor, anX2Y attenuator, and a feedthrough capacitor.
 22. The feedthroughassembly of claim 15, wherein the capacitor comprises an element of amultielement broadband lowpass filter having at least one inductor, themultielement broadband lowpass filter forming one of the groupconsisting of an L filter, a reverse L filter, an LL, a reverse LL, a T,a Pi, and an n-element lowpass filter.
 23. A filter feedthroughassembly, comprising: a) a feedthrough, comprising: i) a ferrule of anelectrically conductive material comprising a ferrule opening defined bya ferrule sidewall having an inner perimeter ferrule surface, whereinthe inner perimeter ferrule surface extends from an inboard ferrule endto a body-fluid ferrule end and wherein the ferrule is configured formounting in an opening in a housing for an active implantable medicaldevice; ii) an insulator of electrically non-conductive materialcomprising an outer perimeter insulator surface extending from aninboard insulator end to a body-fluid insulator end, wherein theinsulator has at least one conductor passageway extending through and tothe inboard and body-fluid insulator ends, and wherein the outerperimeter insulator surface is hermetically sealed to the inner ferrulesurface defining the ferrule opening; and iii) a conductor disposed inthe conductor passageway and hermetically sealed to the insulator,wherein the conductor is in a non-conductive relation with the ferrule,and wherein the conductor extends from an inboard conductor end to abody-fluid conductor end with the opposed inboard and body-fluidconductor ends being spaced from the respective inboard and body-fluidinsulator ends; b) a broadband lowpass filter capacitor configured fordiverting MRI RF pulsed frequency signals induced on the conductorthrough a low equivalent series resistance (ESR) connection to a housingfor an active implantable medical device, the filter capacitorcomprising: i) a dielectric body supporting at least ten activeelectrode plates interleaved with at least ten ground electrode plates;ii) a first metallization electrically connected to the conductor and tothe at least ten active electrode plates; and iii) a secondmetallization electrically connected to the at least ten groundelectrode plates; and iv) a thermal-setting conductive materialelectrically connecting the second metallization to: the inboard ferruleend, the inner perimeter ferrule surface adjacent to the inboard ferruleend, or both; and c) wherein the broadband lowpass filter capacitor has:i) a dielectric constant for the dielectric body of less than 200; ii) atemperature coefficient of capacitance between plus 400 to minus 7112parts per million per degree centigrade (ppm/° C); iii) a capacitance ofbetween 10 and 20,000 picofarads; iv) wherein ESR is the sum of thedielectric loss plus an ohmic loss, and the capacitor comprises adielectric loss tangent measured in ohms at an MRI RF pulsed frequencyor range of frequencies that is less than five percent of thecapacitor's ESR; and v) wherein the capacitor's ESR at an MRI RF pulsedfrequency or range of frequencies is less than 2.0 ohms.
 24. The filterfeedthrough assembly of claim 23, wherein the capacitor's ESR at the MRIRF pulsed frequency or range of frequencies is less than 0.1 ohms. 25.The filter feedthrough assembly of claim 23, wherein the capacitor isselected from the group consisting of a monolithic ceramic capacitor, aflat-through capacitor, a multi-element flat through diverter capacitor,a chip capacitor, an X2Y attenuator, and a feedthrough capacitor. 26.The filter feedthrough assembly of claim 23, wherein the thermal-settingconductive material electrically contacts a noble metal, oxide-resistantattachment supported on the inboard end surface of the ferrule.
 27. Thefilter feedthrough assembly of claim 26, wherein the oxide-resistantattachment comprises a gold braze.
 28. The filter feedthrough assemblyof claim 23 wherein the thermal-setting conductive material is selectedfrom the group consisting of conductive polyimide, solder paste, solderpreform, and braze preform.
 29. A filter feedthrough assembly,comprising: a) a feedthrough, comprising: i) a ferrule of anelectrically conductive material comprising a ferrule opening defined bya ferrule sidewall having an inner perimeter ferrule surface, whereinthe inner ferrule surface extends from an inboard ferrule end to abody-fluid ferrule end and wherein the ferrule is configured formounting in an opening in a housing for an active implantable medicaldevice; ii) an insulator of electrically non-conductive materialcomprising an outer perimeter insulator surface extending from aninboard insulator end to a body-fluid insulator end, wherein theinsulator has at least one conductor passageway extending through and tothe inboard and body-fluid insulator ends, and wherein the outerperimeter insulator surface is hermetically sealed to the inner ferrulesurface defining the ferrule opening; and iii) a conductor hermeticallydisposed through the conductor passageway and hermetically sealed to theinsulator, wherein the conductor is in a non-conductive relation withthe conductive ferrule, and wherein the conductor extends from aninboard conductor end to a body-fluid conductor end with the opposedinboard and body-fluid conductor ends being spaced from the respectiveinboard and body-fluid insulator ends; b) a filter capacitor,comprising: i) a dielectric body supporting at least ten activeelectrode plates interleaved with at least ten ground electrode plates;ii) an inside perimeter metallization electrically connected to theconductor and to the at least ten active electrode plates; iii) anoutside perimeter metallization electrically connected to the at leastten ground electrode plates; and iv) an electrically conductive materialconnecting the outside perimeter metallization to: the inboard ferruleend, the inner perimeter ferrule surface adjacent to the inboard ferruleend, or both; and c) wherein the filter capacitor has: i) a dielectricconstant for the dielectric body of less than 200; ii) a temperaturecoefficient of capacitance between plus 400 to minus 7112 parts permillion per degree centigrade (ppm/° C); iii) a capacitance of between10 and 20,000 picofarads; iv) wherein ESR is the sum of a dielectricloss plus an ohmic loss, and the capacitor comprises a dielectric losstangent measured in ohms at an MRI RF pulsed frequency or range offrequencies that is less than five percent of the capacitor's ESR; andv) wherein the capacitor's ESR at the MRI RF pulsed frequency or rangeof frequencies is less than 2.0 ohms.
 30. The filter feedthroughassembly of claim 29, wherein the MRI RF pulsed frequency or range offrequencies comprises 64 MHz or 128 MHz.
 31. The filter feedthroughassembly of claim 29, wherein the capacitance is between 350 and 10,000picofarads.
 32. The filter feedthrough assembly of claim 29, wherein thecapacitor's ESR at the MRI RF pulsed frequency or range of frequenciesis less than 0.5 ohms.
 33. The filter feedthrough assembly of claim 29,wherein the capacitor's ESR at the MRI RF pulsed frequency or range offrequencies is less than 0.1 ohms.
 34. The filter feedthrough assemblyof claim 29, wherein the dielectric constant is less than
 90. 35. Thefilter feedthrough assembly of claim 29, including an insulative washerbetween the capacitor and the insulator.
 36. The filter feedthroughassembly of claim 29, wherein the electrically conductive material is athermal-setting conductive adhesive.
 37. The filter feedthrough assemblyof claim 36, wherein the thermal-setting conductive adhesiveelectrically contacts a noble metal, oxide-resistant attachmentsupported on at least one of the Inboard ferrule end, the inner ferruleperimeter surface, or both.
 38. The filter feedthrough assembly of claim37, wherein the noble metal, oxide-resistant attachment comprises a goldbraze.
 39. The filter feedthrough assembly of claim 29, wherein thecapacitor is selected from the group consisting of a monolithic ceramiccapacitor, a flat-through capacitor, a multielement flat-throughdiverter capacitor, a chip capacitor, an X2Y attenuator, and afeedthrough capacitor.
 40. The filter feedthrough assembly of claim 29,wherein the capacitor comprises an element of a multielement broadbandlowpass filter having at least one inductor, the multielement broadbandlowpass filter forming one of the group consisting of an L filter, areverse L filter, an LL, a reverse LL, a T, a Pi, and an n-elementlowpass filter.
 41. The filter feedthrough assembly of claim 29, whereinthe ferrule comprises titanium.
 42. The filter feedthrough assembly ofclaim 29, wherein the filter capacitor comprises a broadband lowpassfilter.